Koivusalo Antti I, Pakarinen Mikko P, Lindahl Harry G, Rintala Risto J
Children[Combining Acute Accent]s Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland.
J Pediatr Gastroenterol Nutr. 2016 Apr;62(4):562-6. doi: 10.1097/MPG.0000000000000972.
After repair of oesophageal atresia (OA), the need for endoscopic follow-up (EFU) remains unclear. To end this, we assessed the trends of oesophageal mucosal changes in successive follow-up biopsies.
EFU records of 264 patients including histological grades of oesophagitis (from 0 to III), gastric (GM) or intestinal (IM) metaplasia and dysplasia (mild to severe) at 1, 3, 5 10, 15, and >15 years after repair of OA were reviewed.
Included were 209 patients with 616 biopsies. A total of 60 patients had undergone antireflux surgery and 24 had long-gap OA (LG). Median follow-up was 12 (range 1-17) years with 3 (1-6) endoscopies per patient. Highest grade of oesophagitis was Gr 0 (no oesophagitis) in 47%, Gr I in 37%, and Gr II or III in 16%. Metaplasia, GM (n = 31), IM (n = 4), occurred in 17% of patients and reached 15% prevalence by 15 years. Dysplasia and cancer were not found. From 1 to 15 years after repair grade of histological oesophagitis often fluctuated between Gr 0 and Gr I, but further progression was unlikely, hazard ratio = 0.2-3.4 (95% confidence interval 0.0-29), P = 0.06-0.87. LG and antireflux surgery predicted early detection of metaplasia (P < 0.001). Only 9% of patients with metaplasia and 32% with Gr II oesophagitis were symptomatic. A total of 6 (3%) patients had a symptomatic anastomotic stenosis at 1 year.
EFU revealed frequent oesophagitis and metaplasia, but no dysplasia or cancer. Routine endoscopic surveillance had limited benefit and seems unnecessary during childhood after repair of OA.
食管闭锁（OA）修复术后，内镜随访（EFU）的必要性仍不明确。为解决这一问题，我们评估了连续随访活检中食管黏膜变化的趋势。
回顾了264例患者的EFU记录，包括OA修复术后1、3、5、10、15年及>15年时食管炎的组织学分级（从0到III级）、胃化生（GM）或肠化生（IM）以及发育异常（轻度至重度）。
纳入209例患者，共616次活检。共有60例患者接受了抗反流手术，24例患有长段间隙型OA（LG）。中位随访时间为12年（范围1 - 17年），每位患者平均接受3次（1 - 6次）内镜检查。食管炎最高分级为0级（无食管炎）的患者占47%，I级占37%，II级或III级占16%。化生方面，GM（n = 31）、IM（n = 4）在17%的患者中出现，到15年时患病率达到15%。未发现发育异常和癌症。修复术后1至15年，组织学食管炎分级常于0级和I级之间波动，但进一步进展的可能性不大，风险比 = 0.2 - 3.4（95%置信区间0.0 - 29），P = 0.06 - 0.87。LG和抗反流手术可预测化生的早期发现（P < 0.001）。仅有9%的化生患者和32%的II级食管炎患者有症状。共有6例（3%）患者在1年时出现有症状的吻合口狭窄。
EFU显示食管炎和化生常见，但未发现发育异常或癌症。常规内镜监测益处有限，在OA修复术后的儿童期似乎没有必要。
