Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia

Benjamin Allin, Marian Knight, Paul Johnson, David Burge, BAPS-CASS, Elizabeth Draper, Jennifer Kurinczuk, Sean Marven, Benjamin Allin, Marian Knight, Paul Johnson, David Burge, BAPS-CASS, Elizabeth Draper, Jennifer Kurinczuk, Sean Marven

Abstract

Background and aims: We aimed to provide a contemporaneous assessment of outcomes at one-year post oesophageal atresia/tracheoesophageal fistula (OA-TOF) repair, focussing particularly on post-operative complications. It is generally accepted that oesophageal stricture is the most common complication and causes significant morbidity. We also aimed to assess the efficacy of prophylactic anti-reflux medication (PARM) in reducing stricture formation.

Method: A prospective, multi-centre cohort study of all infants live-born with oesophageal atresia in the United Kingdom and Ireland in 2008/9 was performed, recording clinical management and outcomes at one year. The effect of PARM on stricture formation in infants with the type-c anomaly was assessed using logistic regression analysis.

Results: 151 infants were live-born with oesophageal atresia in the defined reporting period, 126 of whom had the type-c anomaly. One-year follow-up information was returned for 105 infants (70%); the mortality rate was 8.6% (95% CI 4.7-14.3%). Post-operative complications included anastomotic leak (5.4%), recurrent fistula (3.3%) and oesophageal stricture (39%). Seventy-six (60%) of those with type-c anomaly were alive at one-year with returned follow-up, 57(75%) of whom had received PARM. Of these, 24 (42%) developed a stricture, compared to 4 (21%) of those who had not received PARM (adjusted odds ratio 2.60, 95% CI 0.71-9.46, p = 0.147).

Conclusions: This study provides a benchmark for current outcomes and complication rates following OA-TOF repair, with oesophageal stricture causing significant morbidity. The use of PARM appeared ineffective in preventing strictures. This study creates enough doubt about the efficacy of PARM in preventing stricture formation to warrant further investigation of its use with a randomised controlled trial.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Time from anastomosis to diagnosis…
Figure 1. Time from anastomosis to diagnosis of first stricture.
Figure 2. Flow diagram showing number of…
Figure 2. Flow diagram showing number of infants recruited and those who were lost to follow-up.

References

    1. Pinheiro PF, Simoes eACAC, Pereira RM (2012) Current knowledge on esophageal atresia. World Journal of Gastroenterology 18: 3662–3672.
    1. Burge DM, Shah K, Spark P, Shenker N, Pierce M, et al. (2013) Contemporary management and outcomes for infants born with oesophageal atresia. Br J Surg 100: 515–521.
    1. Tennant PWG, Pearce MS, Bythell M, Rankin J 20-year survival of children born with congenital anomalies: a population-based study. The Lancet 375: 649–656.
    1. Alshehri A, Lo A, Baird R (2012) An analysis of early nonmortality outcome prediction in esophageal atresia. Journal of Pediatric Surgery 47: 881–884.
    1. Uchida K, Inoue M, Otake K, Okita Y, Morimoto Y, et al. (2006) Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia. Pediatric surgery international 22: 496–499.
    1. Koivusalo A, Pakarinen MP, Rintala RJ (2009) Anastomotic dilatation after repair of esophageal atresia with distal fistula. Comparison of results after routine versus selective dilatation. Diseases of the Esophagus. pp. 190–194.
    1. Serhal L, Gottrand F, Sfeir R, Guimber D, Devos P, et al. (2010) Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. Journal of Pediatric Surgery 45: 1459–1462.
    1. Health Do (2010) The NHS outcomes framework 2011/12.
    1. Health Do (2010) LIberating the NHS: Transparency in outcomes - a framework for the NHS.
    1. board Nc (2012) Everyone counts: planning for patients 2013/14.
    1. Hvid-Jensen F, Pedersen L, Munk EM, Drewes AM, Funch-Jensen P (2011) Long-term complications to reflux disease in community practice. A 17-year cohort study of 4706 patients. Scandinavian Journal of Gastroenterology 46: 1179–1186.
    1. Pearson EG, Downey EC, Barnhart DC, Scaife ER, Rollins MD, et al. (2010) Reflux esophageal stricture–a review of 30 years’ experience in children. Journal of Pediatric Surgery 45: 2356–2360.
    1. Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S, Eklund S (2006) Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol 101: 2685–2692.
    1. Martin AJ, Pratt N, Kennedy JD, Ryan P, Ruffin RE, et al. (2002) Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics 109: 1061–1067.
    1. Hagander L, Muszynska C, Arnbjornsson E, Sandgren K (2012) Prophylactic treatment with proton pump inhibitors in children operated on for oesophageal atresia. Eur J Pediatr Surg 22: 139–142.
    1. Van Biervliet S, Van Winckel M, Robberecht E, Kerremans I (2001) High-dose omeprazole in esophagitis with stenosis after surgical treatment of esophageal atresia. J Pediatr Surg 36: 1416–1418.
    1. Gross RE, editor (1952) Atresia of the Oesophagus. Philadelphia: Saunders. 75 p.
    1. Owen A, Marven S, Johnson P, Kurinczuk J, Spark P, et al. (2010) Gastroschisis: A national cohort study to describe contemporary surgical strategies and outcomes. Journal of Pediatric Surgery 45: 1808–1816.
    1. Burge DM, Shah K, Spark P, Shenker N, Pierce M, et al. (2013) Contemporary management and outcomes for infants born with oesophageal atresia. Br J Surg 100: 515–521.
    1. Konkin DE, O’Hali WA, Webber EM, Blair GK (2003) Outcomes in esophageal atresia and tracheoesophageal fistula. Journal of Pediatric Surgery 38: 1726–1729.
    1. Jane McKinnon L, Kosloske M (1990) Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. Journal of Pediatric Surgery 25: 778–781.
    1. Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ (1990) Anastomotic stricture following repair of esophageal atresia. J Pediatr Surg 25: 508–511.
    1. Castilloux J, Noble AJ, Faure C (2010) Risk factors for short- and long-term morbidity in children with esophageal atresia. J Pediatr 156: 755–760.
    1. Skarsgard ED (2006) Networks in Canadian paediatric surgery: Time to get connected. Paediatr Child Health 11: 15–18.
    1. Terrin G, Passariello A, De M, Manguso F, Salvia G, et al. (2012) Ranitidine is associated with infections, necrotizing enterocolitis, and fatal outcome in newborns. Pediatrics 129: e40–45.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren