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      An international survey on anastomotic stricture management after esophageal atresia repair: considerations and advisory statements

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          Abstract

          Background

          Endoscopic dilatation is the first-line treatment of stricture formation after esophageal atresia (EA) repair. However, there is no consensus on how to perform these dilatation procedures which may lead to a large variation between centers, countries and doctor’s experience. This is the first cross-sectional study to provide an overview on differences in endoscopic dilatation treatment of pediatric anastomotic strictures worldwide.

          Methods

          An online questionnaire was sent to members of five pediatric medical networks, experienced in treating anastomotic strictures in children with EA. The main outcome was the difference in endoscopic dilatation procedures in various centers worldwide, including technical details, dilatation approach (routine or only in symptomatic patients), and adjuvant treatment options. Descriptive statistics were performed with SPSS.

          Results

          Responses from 115 centers from 32 countries worldwide were analyzed. The preferred approach was balloon dilatation (68%) with a guidewire (66%), performed by a pediatric gastroenterologist ( n = 103) or pediatric surgeon ( n = 48) in symptomatic patients (68%). In most centers, hydrostatic pressure was used for balloon dilatation. The insufflation duration was standardized in 59 centers with a median duration of 60 (range 5–300) seconds. The preferred first-line adjunctive treatments in case of recurrent strictures were intralesional steroids and topical mitomycin C, in respectively 47% and 31% of the centers.

          Conclusions

          We found a large variation in stricture management in children with EA, which confirms the current lack of consensus. International networks for rare diseases are required for harmonizing and comparing the procedures, for which we give several suggestions.

          Electronic supplementary material

          The online version of this article (10.1007/s00464-020-07844-6) contains supplementary material, which is available to authorized users.

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          Most cited references36

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          Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES)

          Gunther Eysenbach (2004)
          Analogous to checklists of recommendations such as the CONSORT statement (for randomized trials), or the QUORUM statement (for systematic reviews), which are designed to ensure the quality of reports in the medical literature, a checklist of recommendations for authors is being presented by the Journal of Medical Internet Research (JMIR) in an effort to ensure complete descriptions of Web-based surveys. Papers on Web-based surveys reported according to the CHERRIES statement will give readers a better understanding of the sample (self-)selection and its possible differences from a “representative” sample. It is hoped that author adherence to the checklist will increase the usefulness of such reports.
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            Early exposure to anesthesia and learning disabilities in a population-based birth cohort.

            Robert Wilder, Randall P. Flick, Juraj Sprung … (2009)
            Anesthetic drugs administered to immature animals may cause neurohistopathologic changes and alterations in behavior. The authors studied association between anesthetic exposure before age 4 yr and the development of reading, written language, and math learning disabilities (LD). This was a population-based, retrospective birth cohort study. The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota, from 1976 to 1982 and who remained in the community at 5 yr of age were reviewed to identify children with LD. Cox proportional hazards regression was used to calculate hazard ratios for anesthetic exposure as a predictor of LD, adjusting for gestational age at birth, sex, and birth weight. Of the 5,357 children in this cohort, 593 received general anesthesia before age 4 yr. Compared with those not receiving anesthesia (n = 4,764), a single exposure to anesthesia (n = 449) was not associated with an increased risk of LD (hazard ratio = 1.0; 95% confidence interval, 0.79-1.27). However, children receiving two anesthetics (n = 100) or three or more anesthetics (n = 44) were at increased risk for LD (hazard ratio = 1.59; 95% confidence interval, 1.06-2.37, and hazard ratio = 2.60; 95% confidence interval, 1.60-4.24, respectively). The risk for LD increased with longer cumulative duration of anesthesia exposure (expressed as a continuous variable) (P = 0.016). Exposure to anesthesia was a significant risk factor for the later development of LD in children receiving multiple, but not single anesthetics. These data cannot reveal whether anesthesia itself may contribute to LD or whether the need for anesthesia is a marker for other unidentified factors that contribute to LD.
            Article 0 comments Cited 301 times – based on 0 reviews     Review now
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              Impact of hospital volume on operative mortality for major cancer surgery.

              C Begg, L Cramer, W J Hoskins … (1998)
              Hospitals that treat a relatively high volume of patients for selected surgical oncology procedures report lower surgical in-hospital mortality rates than hospitals with a low volume of the procedures, but the reports do not take into account length of stay or adjust for case mix. To determine whether hospital volume was inversely associated with 30-day operative mortality, after adjusting for case mix. Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in which the hypothesis was prospectively specified. Surgeons determined in advance the surgical oncology procedures for which the experience of treating a larger volume of patients was most likely to lead to the knowledge or technical expertise that might offset surgical fatalities. All 5013 patients in the SEER registry aged 65 years or older at cancer diagnosis who underwent pancreatectomy, esophagectomy, pneumonectomy, liver resection, or pelvic exenteration, using incident cancers of the pancreas, esophagus, lung, colon, and rectum, and various genitourinary cancers diagnosed between 1984 and 1993. Thirty-day mortality in relation to procedure volume, adjusted for comorbidity, patient age, and cancer stage. Higher volume was linked with lower mortality for pancreatectomy (P=.004), esophagectomy (P<.001), liver resection (P=.04), and pelvic exenteration (P=.04), but not for pneumonectomy (P=.32). The most striking results were for esophagectomy, for which the operative mortality rose to 17.3% in low-volume hospitals, compared with 3.4% in high-volume hospitals, and for pancreatectomy, for which the corresponding rates were 12.9% vs 5.8%. Adjustments for case mix and other patient factors did not change the finding that low volume was strongly associated with excess mortality. These data support the hypothesis that when complex surgical oncologic procedures are provided by surgical teams in hospitals with specialty expertise, mortality rates are lower.
              Article 0 comments Cited 191 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Luigi Dall’Oglio: luigidalloglio@gmail.com
                Journal
                Journal ID (nlm-ta): Surg Endosc
                Journal ID (iso-abbrev): Surg Endosc
                Title: Surgical Endoscopy
                Publisher: Springer US (New York )
                ISSN (Print): 0930-2794
                ISSN (Electronic): 1432-2218
                Publication date (Electronic): 3 August 2020
                Publication date PMC-release: 3 August 2020
                Publication date (Print): 2021
                Volume: 35
                Issue: 7
                Pages: 3653-3661
                Affiliations
                [1 ]GRID grid.416135.4, Department of Pediatric Surgery, , Erasmus University Medical Center - Sophia Children’s Hospital, ; Rotterdam, The Netherlands
                [2 ]GRID grid.414125.7, ISNI 0000 0001 0727 6809, Digestive Endoscopy and Surgery Unit, , Bambino Gesù Children’s Hospital - Research Institute IRCCS, ; Piazza S. Onofrio 4, 00165 Rome, Italy
                [3 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Gastroenterology and Hepatology, , Erasmus University Medical Center, ; Rotterdam, The Netherlands
                [4 ]GRID grid.503422.2, ISNI 0000 0001 2242 6780, Department of Pediatric Gastroenterology Hepatology and Nutrition, , CHU Lille, Univ. Lille, ; Lille, France
                Article
                Publisher ID: 7844
                DOI: 10.1007/s00464-020-07844-6
                PMC ID: 8195894
                PubMed ID: 32748272
                SO-VID: 623f3aad-d6ac-42ab-8727-c0c4bbdd04c6
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 8 April 2020
                Date accepted : 24 July 2020
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature 2021

                ScienceOpen disciplines: Surgery
                Keywords: esophageal atresia,anastomotic strictures,dilatation management
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: esophageal atresia, anastomotic strictures, dilatation management

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