Measuring esophageal anastomotic stricture index as a predictor of dilatation following esophageal atresia surgical repair.

INTRODUCTION

Anastomotic stricture is the most common complication following esophageal atresia (EA) surgical repair. The objective of this study was to evaluate Anastomotic Stricture Index (ASI: relationship between pouch and stricture diameters in the postoperative esophagram) as a predictor of the need for esophageal dilatation.

METHODS

A retrospective review of all patients undergoing EA repair in our healthcare facility from 2009 to 2017 was designed. Proximal pouch ASI (proximal ASI) and distal pouch ASI (distal ASI) in the first and second postoperative esophagram were calculated, and correlation with the number of esophageal dilatations required was studied. For statistical analysis purposes, Spearman's correlation test and ROC curves were used.

RESULTS

Of the 31 patients included, 21 (67.7%) required esophageal dilatation, and 11 (35.5%) required 3 or more dilatations. The relationship between ASIs in the first esophagram and the need for esophageal dilatation was not statistically significant (p >0.05). The relationship between proximal ASI (RHO = 0.84, p <0.05) and the number of dilatations in the second esophagram was statistically significant. None of the patients with <0.55 proximal ASI required dilatation; patients with 0.55-0.79 proximal ASI required less than 3 dilatations; and patients with >0.79 proximal ASI had a high risk of requiring 3 or more dilatations.

CONCLUSION

According to our study, measuring ASI in the second esophagram proves useful in predicting EA patients' postoperative management, especially when it comes to identifying patients with lower risk of undergoing multiple dilatations.