Long-Term Outcome of Esophageal Anastomosis

Rintala, Risto; Pakarinen, Mikko P.

doi:10.1055/s-0033-1347912

Cited by 60 publications

(19 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dysphagia is a common problem [12, 20, 23]. Due to the dysphagia, many children develop adaptive feeding behaviours [11, 20].…”

Section: Introductionmentioning

confidence: 99%

“…Due to the dysphagia, many children develop adaptive feeding behaviours [11, 20]. Dysphagia can occur in association with gastro-oesophageal reflux [5, 6].…”

Section: Introductionmentioning

confidence: 99%

“…Two issues limit the up-to-date knowledge of dysphagia in this population. First, different definitions are used to describe dysphagia [10, 14, 20], which probably explains the wide variability in prevalence of 45 to 70 % [12, 13, 18, 23]. Second, dysphagia can occur in one or more phases of the swallowing process, respectively, the oral, pharyngeal and oesophageal phase.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dysphagia in children with repaired oesophageal atresia

et al. 2016

View full text Add to dashboard Cite

Dysphagia is a common problem in children with repaired oesophageal atresia (OA). Abnormalities in the oropharyngeal and oesophageal phase have hardly been studied. The aims of this study were to assess the prevalence of dysphagia in children with repaired OA and to identify and differentiate oral and pharyngeal dysphagia based on videofluoroscopic swallow study (VFSS) findings in a limited number of children in this cohort. Medical records of 111 patients, born between January 1996 and July 2013 and treated at the Radboudumc Amalia Children’s Hospital, were retrospectively reviewed. The prevalence of dysphagia was determined by the objective and modified Functional Oral Intake Scale (FOIS) in four age groups. The first performed VFSS of 12 children was structurally assessed. The prevalence of dysphagia was 61 of 111 patients (55 %) in age group <1 year. In age group 1–4, 5–11 and 12–18 years, the prevalence of dysphagia decreased from 54 of 106 (51 %) patients to 11 of 64 (17 %) and 5 of 24 (21 %) patients. The 12 VFSS’s reviews revealed oral dysphagia in 36 % and pharyngeal dysphagia in 75 %.Conclusions: This study highlights dysphagia as an important problem in different age groups of children with repaired OA. Furthermore, our study shows the presence of oropharyngeal dysphagia in this population. This study emphasizes the need to standardize the use of objective dysphagia scales, like the modified FOIS, to provide a careful follow-up of children with repaired OA. What is Known: • Prevalence of dysphagia in children with repaired oesophageal atresia varies widely (ranges from 45 to 70 %) in literature. • Oral, pharyngeal and oesophageal dysphagia require different treatment approaches. What is New: • We determined dysphagia based on functional oral intake and provide an overview of change in dysphagia prevalence and severity over time in children with repaired OA. • Our study shows that dysphagia, including oropharyngeal dysphagia, is highly prevalent in young children with repaired OA and improves with time.

show abstract

“…Dysphagia is a common problem [12, 20, 23]. Due to the dysphagia, many children develop adaptive feeding behaviours [11, 20].…”

Section: Introductionmentioning

confidence: 99%

“…Due to the dysphagia, many children develop adaptive feeding behaviours [11, 20]. Dysphagia can occur in association with gastro-oesophageal reflux [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dysphagia in children with repaired oesophageal atresia

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Retrospective series reported an increased incidence of ASs in children with GERD (3, 4). AS is reported as a possible complication also in the 8–15% of adult AE patients; as these strictures most likely arise as a result of prolonged acidic reflux, the far-reaching significance of GERD in these adult patients is further underlined (37). However, a multivariate analysis showed the absence of an association between GERD and subsequent stricture formation, probably due to the prescription of a systematic proton pump inhibitor (PPI) (7).…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

et al. 2017

View full text Add to dashboard Cite

Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient’s age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.

show abstract

“…Follow-up studies have shown that most EA patients have a favourable long-term outcome despite persistant digestive and respiratory problems. Common gastrointestinal symptoms after EA repair are dysphagia and gastroesophageal reflux (GER) in up to 72% and 67% of the patients, respectively[ 4 , 5 ]. Chronic GER after EA repair might lead to mucosal damage, esophageal stricturing, Barrett’s esophagus and eventually esophageal adenocarcinoma (EAC)[ 5 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Four cancer cases after esophageal atresia repair: Time to start screening the upper gastrointestinal tract

Vergouwe

Gottrand

Wijnhoven

et al. 2018

WJG

View full text Add to dashboard Cite

Esophageal atresia (EA) is one of the most common congenital digestive malformations and requires surgical correction early in life. Dedicated centers have reported survival rates up to 95%. The most frequent comorbidities after EA repair are dysphagia (72%) and gastroesophageal reflux (GER) (67%). Chronic GER after EA repair might lead to mucosal damage, esophageal stricturing, Barrett’s esophagus and eventually esophageal adenocarcinoma. Several long-term follow-up studies found an increased risk of Barrett’s esophagus and esophageal carcinoma in EA patients, both at a relatively young age. Given these findings, the recent ESPGHAN-NASPGHAN guideline recommends routine endoscopy in adults born with EA. We report a series of four EA patients who developed a carcinoma of the gastrointestinal tract: three esophageal carcinoma and one colorectal carcinoma in a colonic interposition. These cases emphasize the importance of lifelong screening of the upper gastrointestinal tract in EA patients.

show abstract

Long-Term Outcome of Esophageal Anastomosis

Cited by 60 publications

References 46 publications

Dysphagia in children with repaired oesophageal atresia

Dysphagia in children with repaired oesophageal atresia

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

Four cancer cases after esophageal atresia repair: Time to start screening the upper gastrointestinal tract

Contact Info

Product

Resources

About