Multidisciplinary care of children with repaired esophageal atresia and tracheoesophageal fistula

DeBoer, Emily M.; Prager, Jeremy D.; Ruiz, Amanda G.; Jensen, Emily L.; Deterding, Robin R.; Friedlander, Joel A.; Soden, Jason

doi:10.1002/ppul.23330

Cited by 63 publications

(74 citation statements)

References 19 publications

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“…When evaluated by a multidisciplinary team, all the children in this study were found to have tracheomalacia, and multiple others had their diagnosis changed resulting in a change in medications. [123] A separate study showed how respiratory symptoms are often overlooked in children with repaired EA. [124] When evaluating lung function in 31 children, 45% of them had poor ventilatory response, and of these children, 77% were not on any pulmonary directed treatment.…”

Section: Extraintestinal Manifestationsmentioning

confidence: 99%

“…[121] Lavage fluid also allows for identification of pathogenic organisms diagnostic of chronic pneumonia. [123] Laryngoscopy allows for identification of laryngeal cleft and subglottic stenosis. Chest computerized tomography may be indicated in chronic pulmonary symptoms and infections to help identify bronchiectasis, pneumonia, and atelectasis.…”

Section: Extraintestinal Manifestationsmentioning

confidence: 99%

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How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

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EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

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Section: Extraintestinal Manifestationsmentioning

confidence: 99%

Section: Extraintestinal Manifestationsmentioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

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“…Until additional data are available, there is a compelling need for long-term follow-up of these patients, ideally by multidisciplinary expert teams, both during childhood and during adulthood (4, 66). Respiratory follow-up should include serial PFTs including spirometry, measurement of lung volumes, and, possibly, evaluation of bronchodilator responsiveness (67, 68).…”

Section: Discussionmentioning

confidence: 99%

“…Using CT scanning, rates of bronchiectasis in EA/TEF survivors may be as high as 27% (4, 55). While neither DeBoer et al (4) nor Cartabuke et al (60) examined potential associations with bronchiectasis (59), bronchiectasis in this population has generally been associated with massive aspiration, including patients with gastric or colonic interposition in a selected referral population (22), longstanding GERD (61), massive TEF pouch secretions, trisomy 21 (62), undiagnosed TEF (63), or broncho-esophageal fistula (64, 65). …”

Section: Associations With Respiratory Morbidity In Patients With Repmentioning

confidence: 99%

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Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia

Kovesi

2017

Front. Pediatr.

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Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with tracheoesophageal fistula (EA/TEF). EA/TEF patients are at high risk of having aspiration, and retrospective studies have associated CRM with both recurrent aspiration and atopy. However, studies evaluating the association between CRM in this population and either aspiration or atopy have reported conflicting results. Furthermore, CRM in this population may be due to other related conditions as well, such as tracheomalacia and/or recurrent infections. Aspiration is difficult to confirm, short of lung biopsy. Moreover, even within the largest evidence base assessing the association between CRM and aspiration, which has evaluated the potential relationship between gastroesophageal reflux and asthma, findings are contradictory. Studies attempting to relate CRM to prior aspiration events may inadequately estimate the frequency and severity of previous aspiration episodes. There is convincing evidence documenting that chronic, massive aspiration in patients with repaired EA/TEF is associated with the development of bronchiectasis. While chronic aspiration is likely associated with other CRM in patients with repaired EA/TEF, this does not appear to have been confirmed by the data currently available. Prospective studies that systematically evaluate aspiration risk and allergic disease in patients with repaired EA/TEF and document subsequent CRM will be needed to clarify the causes of CRM in this population. Given the prevalence of CRM, patients with repaired EA/TEF should ideally receive regular follow-up by multidisciplinary teams with expertise in this condition, throughout both childhood and adulthood.

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Consensus on Triple Endoscopy Data Elements Preparatory to Development of an Aerodigestive Registry

et al. 2022

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Objectives/Hypothesis: This study defines essential data elements to be recorded during an aerodigestive "triple endoscopy" to form the foundation of a standardized multicenter registry and to clearly define measurement of each consensus item.Study Design: Modified Delphi process.Methods: Modified Delphi consensus with six survey rounds. Twenty-four expert pediatric otolaryngology, pulmonology, and gastroenterology aerodigestive clinicians from eight large academic pediatric aerodigestive programs formed the Delphi panel. After achieving consensus through the Delphi process, outside validation was performed at 2019 national Aerodigestive Society conference. Consensus, near-consensus, or exclusion was obtained for each proposed data element. Concordance was then measured between expert panel conclusions and validation group conclusions.Results: Overall response rate was 94.4%. 73/167 proposed items reached consensus in six domains (flexible bronchoscopy, bronchoalveolar lavage, microdirect laryngoscopy and bronchoscopy, esophagogastroduodenoscopy with biopsies, and esophageal impedance and pH probe). Measurement of all items was defined; classification/grading systems were selected for 11 items. Validation group endorsed importance of 82/167 data items; compared to expert consensus, overall, inclusion, and exclusion concordance rates were 94.5%, 98.7%, and 90.9%. Conclusion:Triple endoscopy is a central component of aerodigestive care. This study identifies and defines data elements to be recorded for all triple endoscopy procedures. The list is of usable length, and clear definitions were created for all items, with explicit classification/grading systems selected for 11 items. Face validity was confirmed with an independent multispecialty sample of aerodigestive providers. This consensus provides the foundation for a triple endoscopy registry but also is immediately applicable to standardize clinical documentation in aerodigestive care.

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Multidisciplinary care of children with repaired esophageal atresia and tracheoesophageal fistula

Cited by 63 publications

References 19 publications

How to Care for Patients with EA-TEF: The Known and the Unknown

How to Care for Patients with EA-TEF: The Known and the Unknown

Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia

Consensus on Triple Endoscopy Data Elements Preparatory to Development of an Aerodigestive Registry

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