Classification of Esophageal Strictures following Esophageal Atresia Repair

Abstract

Introduction: The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations.

Materials and methods: A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SI_XR) and endoscopically (SI_END). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis.

Results: In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8-232.5, median: 97.6). The mean SI_XR was 0.56 ± 0.16 (range: 0.15-0.86). The mean SI_END was 0.45 ± 0.22 (range: 0.15-0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1-9). The number of dilations was poorly correlated with SI_XR, while significantly correlated with SI_END. Patients who did not need dilations had a SI_END < 0.33, patients who needed only one dilation had 0.33 ≤ SI_END < 0.44, and those with SI_END ≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy.

Conclusion: SI_END is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SI_END becomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.