Classification of Esophageal Strictures following Esophageal Atresia Repair.

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) and endoscopically (SI). 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 was 0.56 ± 0.16 (range: 0.15-0.86). The mean SI 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, while significantly correlated with SI. Patients who did not need dilations had a SI < 0.33, patients who needed only one dilation had 0.33 ≤ SI < 0.44, and those with SI ≥ 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 is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SI 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.