Esophageal morbidity in patients following repair of esophageal atresia: A systematic review

Assia Comella; Sharman P Tan Tanny; John M Hutson; Taher I Omari; Warwick J Teague; Ramesh M Nataraja; Sebastian K King

doi:10.1016/j.jpedsurg.2020.09.010

Esophageal morbidity in patients following repair of esophageal atresia: A systematic review

J Pediatr Surg. 2021 Sep;56(9):1555-1563. doi: 10.1016/j.jpedsurg.2020.09.010. Epub 2020 Sep 19.

Authors

Assia Comella¹, Sharman P Tan Tanny², John M Hutson³, Taher I Omari⁴, Warwick J Teague³, Ramesh M Nataraja⁵, Sebastian K King³

Affiliations

¹ Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia, 3052; Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia, 3052; School of Medicine, Monash University, Melbourne, Australia, 3800. Electronic address: assia.comella@gmail.com.
² Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia, 3052; Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia, 3052; Department of Paediatrics, University of Melbourne, Melbourne, Australia, 3010; Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia, 3168.
³ Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia, 3052; Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia, 3052; Department of Paediatrics, University of Melbourne, Melbourne, Australia, 3010.
⁴ Department of Human Physiology, Flinders University, Adelaide, Australia, 5042.
⁵ Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia, 3168; Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia, 3800.

PMID: 33051081
DOI: 10.1016/j.jpedsurg.2020.09.010

Abstract

Background: Esophageal atresia (EA) is a life-threatening congenital condition, affecting one in 2600 newborns. Morbidity remains high, with many patients experiencing complications, including anastomotic leak/stricture, and gastro-esophageal reflux disease (GERD). Increased understanding of esophageal motility patterns may help explain the etiology of these complications.

Aims: We aimed to review knowledge regarding esophageal motility and related complications in children with EA, evaluate patients' symptomatology and relate this to esophageal motility.

Methods: We performed a systematic review (PROSPERO: CRD42018092277), according to the PRISMA protocol. Two investigators independently conducted search strategies (OvidMEDLINE, PubMed, Cochrane Review, BMJ BestPractice), identifying complications in patients following EA repair. Rates of esophageal dysmotility, GERD, dysphagia, anastomotic leak, anastomotic stricture, recurrent fistula formation, and esophagitis were sought.

Results: A total of 65 publications met selection criteria (n = 4882). Rates of morbidity were high: esophageal dysmotility (78%), GERD (43%), dysphagia (44%), anastomotic leak (19%), anastomotic stricture (26%), recurrent fistula formation (7%), and esophagitis (47%). No correlation appeared to exist with severity of symptoms.

Conclusions: This systematic review identified high rates of complications in children with EA, with esophageal dysmotility present in the majority of patients. Increasing survival, with resultant longer timeframes to develop morbidities, makes standardized follow-up regimens crucial.

Type of study: Prognosis study.

Level of evidence: Level 3.

Keywords: Dysphagia; Esophageal atresia; Follow-up; Motility; Systematic review.

Publication types

Review
Systematic Review

MeSH terms

Child
Esophageal Atresia* / surgery
Esophageal Motility Disorders* / epidemiology
Esophageal Motility Disorders* / etiology
Humans
Infant, Newborn
Morbidity
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Tracheoesophageal Fistula* / epidemiology
Tracheoesophageal Fistula* / etiology
Tracheoesophageal Fistula* / surgery