Long-term outcomes of oesophageal atresia without or with proximal tracheooesophageal fistula – Gross types A and B

Koivusalo, Antti; Sistonen, Saara J.; Lindahl, Harry; Rintala, Risto J.; Pakarinen, Mikko P.

doi:10.1016/j.jpedsurg.2017.04.021

Cited by 17 publications

(8 citation statements)

References 28 publications

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“…Recent large studies have identified the prevalence of EA to be 2.3‐2.4 cases per 10 000 births . In the last decade, survival has increased to 91%‐98% . EA has a high incidence of associated anomalies, ranging from 31% to 59% .…”

Section: Introductionmentioning

confidence: 99%

Prenatal detection of esophageal atresia: A systematic review and meta‐analysis

Pardy

D’Antonio

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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Introduction:The primary aim of this systematic review was to quantify the diagnostic performance of ultrasound, magnetic resonance imaging and amniotic fluid analysis in detecting esophageal atresia prenatally. The secondary aim was to explore the accuracy of individual imaging signs in identifying this anomaly.Material and methods: MEDLINE, Embase and Cochrane databases were searched.The quality of studies was assessed using the revised tool for the quality assessment of diagnostic accuracy studies. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio for the predictive accuracy of ultrasound, magnetic resonance imaging and amniotic fluid analysis in detecting esophageal atresia were computed using the hierarchical summary receiver operating characteristic or DerSimonian-Laird random-effect model, according to the number of studies included in each analysis. PROSPERO registration number: CRD42017055828.Results: Twenty studies (73 246 fetuses, 1760 affected by esophageal atresia) were included. Overall, prenatal ultrasound had a sensitivity of 31.7%. Only two studies reported all data for diagnostic accuracy; based on these studies, prenatal ultrasound had a sensitivity of 41.9%, a specificity of 99.9%, a positive likelihood ratio of 88.1, a negative likelihood ratio of 0.58 and a diagnostic odds ratio of 153.7. Prenatal ultrasound correctly identified 77.9% of cases with esophageal atresia and 21.9% esophageal atresia with an associated tracheo-esophageal fistula. Polyhydramnios was present in 56.3% of cases affected by esophageal atresia, and a small or absent stomach was identified in 50.0% cases. When performed following a suspicious ultrasound, fetal magnetic resonance imaging had an good overall diagnostic accuracy for esophageal atresia, with a sensitivity of 94.7%, a specificity of 89.3%, a positive likelihood ratio of 8.8, a negative likelihood ratio of 0.06 and a diagnostic odds ratio of 149.3. Finally, amniotic fluid analysis with an esophageal atresia index ≥3 had a sensitivity of 89.9% and a specificity of 99.6% in detecting esophageal atresia. Conclusions:Ultrasound alone is a poor diagnostic tool for identifying esophageal atresia prenatally, and has a high rate of false positive diagnoses. Magnetic resonance imaging and amniotic fluid analysis have high diagnostic accuracy for esophageal atresia. We would recommend their use following a suspicious ultrasound.

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Section: Introductionmentioning

confidence: 99%

Prenatal detection of esophageal atresia: A systematic review and meta‐analysis

Pardy

D’Antonio

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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“…From studies reporting endoscopic surveillance, in six patients gastric metaplasia preceded intestinal metaplasia on sequential endoscopies, with gastric metaplasia occurring 1–5 years prior 21 , 22 . While there were two reported cases of resolution of BO (1 gastric and 1 intestinal) either spontaneously or following anti-reflux treatment, the majority of cases of BO persisted 9 , 47 , 66 . Gastric and intestinal metaplasia were present concurrently at screening endoscopy in four patients 22 .…”

Section: Resultsmentioning

confidence: 97%

Barrett’s oesophagus and oesophageal cancer following oesophageal atresia repair: a systematic review

et al. 2021

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Background Concern exists that patients born with oesophageal atresia (OA) may be at high risk for Barrett’s oesophagus (BO), a known malignant precursor to the development of oesophageal adenocarcinoma. Screening endoscopy has a role in early BO identification but is not universal in this population. This study aimed to determine prevalence of BO after OA repair surgery, to quantify the magnitude of this association and inform the need for screening and surveillance. Methods A systematic review, undertaken according to PRISMA guidelines, was preregistered on PROSPERO (CRD42017081001). PubMed and EMBASE were interrogated using a standardized search strategy on 31 July 2020. Included papers, published in English, reported either: one or more patients with either BO (gastric/intestinal metaplasia) or oesophageal cancer in patients born with OA; or long-term (greater than 2 years) follow-up after OA surgery with or without endoscopic screening or surveillance. Results Some 134 studies were identified, including 19 case reports or series and 115 single- or multi-centre cohort studies. There were 13 cases of oesophageal cancer (9 squamous cell carcinoma, 4 adenocarcinoma) with a mean age at diagnosis of 40.5 (range 20–47) years. From 6282 patients under long-term follow-up, 317 patients with BO were reported. Overall prevalence of BO was 5.0 (95 per cent c.i. 4.5 to 5.6) per cent, with a mean age at detection of 13.8 years (range 8 months to 56 years). Prevalence of BO in series reporting endoscopic screening or surveillance was 12.8 (95 per cent c.i. 11.3 to 14.5) per cent. Conclusion Despite a limited number of cancers, the prevalence of BO in patients born with OA is relatively high. While limited by the quality of available evidence, this review suggests endoscopic screening and surveillance may be warranted, but uncertainties remain over the design and effectiveness of any putative programme.

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“…In a cohort of 31 patients with EA without fistula, Holland et al found long‐term sequelae in 67.7% of cases, with the need for multiple additional surgical procedures . In a long‐term outcome study, with a median follow‐up of 35 years (interquartile range, 7.4‐40 y), Koivusalo et al described high morbidity among survivors of EA types A and B . However, compared with the whole series from 1947 to 2014 (63%), they observed an excellent survival rate in the last years of the study (93% during the period 1985‐2014).…”

Section: Discussionmentioning

confidence: 99%