Anastomotic stricture prediction in patients with esophageal atresia with distal fistula.
Pediatr Surg Int
; 39(1): 136, 2023 Feb 22.
Article
in En
| MEDLINE
| ID: mdl-36811679
ABSTRACT
PURPOSE:
To investigate potential early risk factors for anastomotic stricture formation and assess the predictive role of post-operative esophagrams.METHODS:
A retrospective study of patients with esophageal atresia with distal fistula (EA/TEF) operated between 2011 and 2020. Fourteen predictive factors were tested for stricture development. Esophagrams were used to calculate early (SI1) and late (SI2) stricture index (SI = anastomosis diameter/upper pouch diameter).RESULTS:
Of 185 patients operated for EA/TEF in the 10-year period, 169 patients met the inclusion criteria. Primary anastomosis was performed in 130 patients and delayed anastomosis in 39 patients. Stricture formed in 55 patients (33%) within 1 year from anastomosis. Four risk factors showed strong association with stricture formation in unadjusted models long gap (p = 0.007), delayed anastomosis (p = 0.042), SI1 (p = 0.013) and SI2 (p < 0.001). A multivariate analysis showed SI1 as significantly predictive of stricture formation (p = 0.035). Cut-off values using a receiver operating characteristic (ROC) curve were 0.275 for SI1 and 0.390 for SI2. The area under the ROC curve demonstrated increasing predictiveness from SI1 (AUC 0.641) to SI2 (AUC 0.877).CONCLUSIONS:
This study identified an association between long gap and delayed anastomosis with stricture formation. Early and late stricture indices were predictive of stricture formation.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Tracheoesophageal Fistula
/
Esophageal Atresia
/
Esophageal Stenosis
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
Pediatr Surg Int
Journal subject:
PEDIATRIA
Year:
2023
Document type:
Article
Affiliation country:
Czech Republic