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Eur J Pediatr Surg 2017; 27(01): 050-055
DOI: 10.1055/s-0036-1593607
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Risk Factors for Anastomotic Strictures after Esophageal Atresia Repair: Prophylactic Proton Pump Inhibitors Do Not Reduce the Incidence of Strictures

Felipe Donoso
1   Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
2   Department of Pediatric surgery, Akademiska Barnsjukhuset, Uppsala, Sweden
,
Helene Engstrand Lilja
1   Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
2   Department of Pediatric surgery, Akademiska Barnsjukhuset, Uppsala, Sweden
› Institutsangaben
Weitere Informationen

Publikationsverlauf

12. Mai 2016

19. August 2016

Publikationsdatum:
21. Oktober 2016 (online)

    Lizenzen und Reprints

Abstract

Background Since 2005, infants with esophageal atresia (EA) in our unit are given prophylactic proton pump inhibitors (PPI) after repair until 1 year of age. The aims of this study were to identify risk factors for anastomotic strictures (AS) and to assess the efficacy of postoperative PPI prophylaxis in reducing the incidence of AS compared with symptomatic PPI.

Methods Patients who underwent EA repair from 1994 to 2013 in our unit were included in this retrospective observational study approved by the local ethics review board. They were divided into two subgroups; symptomatic PPI-group with EA repair from 1994 to 2004 and prophylactic PPI-group with EA repair from 2005 to 2013. Data were collected from the patient records. Potential risk factors for AS analyzed were gender, long gap EA, birth weight, premature birth (<37 gestational weeks), anastomotic tension, and anastomotic leakage. Number of dilatations until the age of 1 and 5 years were recorded. To evaluate risk factors for AS and the effect of prophylactic PPI Logistic, Cox and Poisson regression models were used. For descriptive statistics Fisher exact test and Wilcoxon rank sum test were used.

Results A total of 128 patients were included. Patient characteristics, surgical method, grading of anastomotic tension, complications, and survival rates did not differ significantly between the symptomatic PPI-group (n = 71) and the prophylactic PPI-group (n = 57). Comparing the symptomatic and prophylactic PPI-group, there was no significant difference in the median age at the first AS (9.3 vs 6 mo), the number of dilatations until 1 year (2 vs 2) and 5 years (5 vs 4), or the incidence of anastomotic stricture (56.5% vs 50.9%). Long gap EA, high birth weight, and anastomotic tension were found to be independent risk factors.

Conclusion Surgeons should aim to perform anastomosis under less tension at EA repair. Prophylactic PPI-treatment does not appear to reduce the rate of AS. Randomized controlled trials with larger study populations are needed to further evaluate the efficacy of prophylactic PPI.

Keywords

esophageal atresia - PPI - proton pump inhibitor - risk factor - stricture
 

  • References

  • 1 Spitz L. Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 2006; 41 (10) 1635-1640
    CrossrefPubMedGoogle Scholar
  • 2 Pedersen RN, Calzolari E, Husby S, Garne E ; EUROCAT Working group. Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child 2012; 97 (3) 227-232
    CrossrefPubMedGoogle Scholar
  • 3 Oddsberg J, Lu Y, Lagergren J. Aspects of esophageal atresia in a population-based setting: incidence, mortality, and cancer risk. Pediatr Surg Int 2012; 28 (3) 249-257
    CrossrefPubMedGoogle Scholar
  • 4 Sfeir R, Bonnard A, Khen-Dunlop N , et al. Esophageal atresia: data from a national cohort. J Pediatr Surg 2013; 48 (8) 1664-1669
    CrossrefPubMedGoogle Scholar
  • 5 Pini Prato A, Carlucci M, Bagolan P , et al. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50 (9) 1441-1456
    CrossrefPubMedGoogle Scholar
  • 6 Haight C, Towsley H. Congenital atresia of the esophagus with tracheoesophageal fistula. Extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments. Surg Gynecol Obstet 1943; 76: 672-688
    PubMedGoogle Scholar
  • 7 Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Snyder CL, Sigalet DL. Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 1999; 34 (1) 70-73 , discussion 74
    CrossrefPubMedGoogle Scholar
  • 8 Deurloo JA, Ekkelkamp S, Schoorl M, Heij HA, Aronson DC. Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg 2002; 73 (1) 267-272
    CrossrefPubMedGoogle Scholar
  • 9 Tönz M, Köhli S, Kaiser G. Oesophageal atresia: what has changed in the last 3 decades?. Pediatr Surg Int 2004; 20 (10) 768-772
    CrossrefPubMedGoogle Scholar
  • 10 Orford J, Cass DT, Glasson MJ. Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s. Pediatr Surg Int 2004; 20 (6) 402-407
    PubMedGoogle Scholar
  • 11 Lopez PJ, Keys C, Pierro A , et al. Oesophageal atresia: improved outcome in high-risk groups?. J Pediatr Surg 2006; 41 (2) 331-334
    CrossrefPubMedGoogle Scholar
  • 12 Konkin DE, O'hali WA, Webber EM, Blair GK. Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2003; 38 (12) 1726-1729
    CrossrefPubMedGoogle Scholar
  • 13 Donoso F, Kassa AM, Gustafson E, Meurling S, Lilja HE. Outcome and management in infants with esophageal atresia—a single centre observational study. J Pediatr Surg 2016; DOI: 10.1016/j.jpedsurg.2016.03.010.
    PubMedGoogle Scholar
  • 14 Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ. Anastomotic stricture following repair of esophageal atresia. J Pediatr Surg 1990; 25 (5) 508-511
    CrossrefPubMedGoogle Scholar
  • 15 Mortell AE, Azizkhan RG. Esophageal atresia repair with thoracotomy: the Cincinnati contemporary experience. Semin Pediatr Surg 2009; 18 (1) 12-19
    CrossrefPubMedGoogle Scholar
  • 16 Lilja HE, Wester T. Outcome in neonates with esophageal atresia treated over the last 20 years. Pediatr Surg Int 2008; 24 (5) 531-536
    CrossrefPubMedGoogle Scholar
  • 17 Lacher M, Froehlich S, von Schweinitz D, Dietz HG. Early and long term outcome in children with esophageal atresia treated over the last 22 years. Klin Padiatr 2010; 222 (5) 296-301
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 18 Koivusalo AI, Pakarinen MP, Rintala RJ. Modern outcomes of oesophageal atresia: single centre experience over the last twenty years. J Pediatr Surg 2013; 48 (2) 297-303
    CrossrefPubMedGoogle Scholar
  • 19 Dingemann C, Dietrich J, Zeidler J , et al. Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million. Dis Esophagus 2015; DOI: 10.1111/dote.12369.
    PubMedGoogle Scholar
  • 20 Burge DM, Shah K, Spark P , et al; British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS). Contemporary management and outcomes for infants born with oesophageal atresia. Br J Surg 2013; 100 (4) 515-521
    CrossrefPubMedGoogle Scholar
  • 21 Schneider A, Blanc S, Bonnard A , et al. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J Rare Dis 2014; 9 (206) DOI: 10.1186/s13023-014-0206-5.
    PubMedGoogle Scholar
  • 22 Shawyer AC, Pemberton J, Flageole H. Post-operative management of esophageal atresia-tracheoesophageal fistula and gastroesophageal reflux: a Canadian Association of Pediatric Surgeons annual meeting survey. J Pediatr Surg 2014; 49 (5) 716-719
    CrossrefPubMedGoogle Scholar
  • 23 Guda NM, Vakil N. Proton pump inhibitors and the time trends for esophageal dilation. Am J Gastroenterol 2004; 99 (5) 797-800
    CrossrefPubMedGoogle Scholar
  • 24 Ruigómez A, García Rodríguez LA, Wallander M-A, Johansson S, Eklund S. Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol 2006; 101 (12) 2685-2692
    CrossrefPubMedGoogle Scholar
  • 25 Shawyer AC, D'Souza J, Pemberton J, Flageole H. The management of postoperative reflux in congenital esophageal atresia-tracheoesophageal fistula: a systematic review. Pediatr Surg Int 2014; 30 (10) 987-996
    CrossrefPubMedGoogle Scholar
  • 26 Hagander L, Muszynska C, Arnbjornsson E, Sandgren K. Prophylactic treatment with proton pump inhibitors in children operated on for oesophageal atresia. Eur J Pediatr Surg 2012; 22 (2) 139-142
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 27 Stenström P, Anderberg M, Börjesson A, Arnbjornsson E. Prolonged use of proton pump inhibitors as stricture prophylaxis in infants with reconstructed esophageal atresia. Eur J Pediatr Surg 2016; DOI: 10.1055/s-0036-1584179.
    PubMedGoogle Scholar
  • 28 Allin B, Knight M, Johnson P , et al. Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS One 2014; 9 (8) e106149
    CrossrefPubMedGoogle Scholar
  • 29 Gross RE. The Surgery of Infancy and Childhood. Philadelphia, PA: WB Saunders; 1953
    Google Scholar
  • 30 Ellis H. The causes and prevention of intestinal adhesions. Br J Surg 1982; 69 (5) 241-243
    CrossrefPubMedGoogle Scholar
  • 31 McKinnon LJ, Kosloske AM. Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 1990; 25 (7) 778-781
    CrossrefPubMedGoogle Scholar
  • 32 Serhal L, Gottrand F, Sfeir R , et al. Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. J Pediatr Surg 2010; 45 (7) 1459-1462
    CrossrefPubMedGoogle Scholar
  • 33 Parolini F, Leva E, Morandi A , et al. Anastomotic strictures and endoscopic dilatations following esophageal atresia repair. Pediatr Surg Int 2013; 29 (6) 601-605
    CrossrefPubMedGoogle Scholar
  • 34 Castilloux J, Noble AJ, Faure C. Risk factors for short- and long-term morbidity in children with esophageal atresia. J Pediatr 2010; 156 (5) 755-760
    CrossrefPubMedGoogle Scholar
  • 35 Shah R, Varjavandi V, Krishnan U. Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula. Dis Esophagus 2015; 28 (3) 216-223
    CrossrefPubMedGoogle Scholar
  • 36 Okata Y, Maeda K, Bitoh Y , et al. Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula. Pediatr Surg Int 2016; 32 (9) 869-873
    CrossrefPubMedGoogle Scholar