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Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study
  1. Floor W T Vergouwe1,2,
  2. John Vlot1,
  3. Hanneke IJsselstijn1,
  4. Manon C W Spaander2,
  5. Joost van Rosmalen3,
  6. Matthijs W N Oomen4,
  7. Jan B F Hulscher5,
  8. Marc Dirix6,
  9. Marco J Bruno2,
  10. Maarten Schurink7,
  11. René M H Wijnen1
  12. on behalf of the DCEA Study Group
  1. 1 Department of Paediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center–Sophia Children’s Hospital, Rotterdam, The Netherlands
  2. 2 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  3. 3 Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  4. 4 Department of Paediatric Surgery, Paediatric Surgical Center of Amsterdam (Academic Medical Center and VU Medical Center), Amsterdam, The Netherlands
  5. 5 Department of Paediatric Surgery, University Medical Center Groningen-Beatrix Children’s Hospital, Groningen, The Netherlands
  6. 6 Department of Paediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
  7. 7 Department of Paediatric Surgery, Radboud University Medical Center-Amalia Children’s Hospital, Nijmegen, The Netherlands
  1. Correspondence to Dr John Vlot, Department of Paediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center–Sophia Children’s Hospital, 3000 CA Rotterdam, The Netherlands; john.vlot{at}erasmusmc.nl

Abstract

Objective To determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures.

Methods Retrospective national multicentre study in patients with OA born between 1999 and 2013. Exclusion criteria were isolated fistula, inability to obtain oesophageal continuity, death prior to discharge and follow-up <6 months. A refractory oesophageal stricture was defined as an anastomotic stricture requiring ≥5 dilations at maximally 4-week intervals. Risk factors for development of refractory anastomotic strictures after OA repair were identified with multivariable logistic regression analysis.

Results We included 454 children (61% male, 7% isolated OA (Gross type A)). End-to-end anastomosis was performed in 436 (96%) children. Anastomotic leakage occurred in 13%. Fifty-eight per cent of children with an end-to-end anastomosis developed an anastomotic stricture, requiring a median of 3 (range 1–34) dilations. Refractory strictures were found in 32/436 (7%) children and required a median of 10 (range 5–34) dilations. Isolated OA (OR 5.7; p=0.012), anastomotic leakage (OR 5.0; p=0.001) and the need for oesophageal dilation ≤28 days after anastomosis (OR 15.9; p<0.001) were risk factors for development of a refractory stricture.

Conclusions The incidence of refractory strictures of the end-to-end anastomosis in children treated for OA was 7%. Risk factors were isolated OA, anastomotic leakage and the need for oesophageal dilation less than 1 month after OA repair.

  • oesophageal atresia
  • outcome
  • oesophageal strictures
  • oesophageal dilation procedures
  • risk factors
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Footnotes

  • Contributors Study conception and design: FWTV, JV, HI, MCWS, JvR and RMHW. Acquisition of data: FWTV and MS. Analysis and interpretation of data: FWTV, JV, HI, MCWS, JvR, MWNO, JBFH, MD, MJB, MS and RMHW. Drafting of manuscript: FWTV, JV, HI, MCWS, MJB and RMHW. Critical revision: FWTV, JV, HI, MCWS, JvR, MWNO, JBFH, MD, MJB, MS and RMHW. All authors (FWTV, JV, HI, MCWS, JvR, MWNO, JBFH, MD, MJB, MS and RMHW) gave their final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Medical Ethics Committee of Erasmus MC Rotterdam

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators See the online supplementary appendix for a list of the DCEA Study Group members of the participating centres.

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