van Lennep M, Mussies C, Benninga M A, Gorter R R, Krishnan U, van Wijk M P
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital Amsterdam University Medical Center, Amsterdam, The Netherlands.
Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, The Netherlands.
Dis Esophagus. 2025 Jan 7;38(2). doi: 10.1093/dote/doaf022.
According to the European Society for Paediatric Gastroenterology Hepatology And Nutrition & North American Society For Pediatric Gastroenterology, Hepatology And Nutrition (ESPGHAN-NASPGHAN) guideline, esophageal atresia (EA) patients should routinely undergo esophagogastroduodenoscopy (EGD) with biopsies and/or pH-impedance (pH multichannel intraluminal impedance test; pH-MII) for surveillance purposes. It is additionally recommended to perform these procedures when there is a clinical indication: symptoms suggestive of gastroesophageal reflux disease or eosinophilic esophagitis. The aim of this study was to evaluate how often EGD/pH-MII outcomes change management decisions in EA children who come for surveillance and/or for clinical evaluation of their symptoms. A retrospective chart review was conducted of all EA patients who received EGD and/or pH-MII for routine surveillance or because of clinical indication, i.e. symptoms suggestive of gastroesophageal reflux disease or eosinophilic esophagitis. For each procedure, we assessed whether outcomes changed management decisions. Between 2017 and 2020, 41 patients (median age 2.0 [1.0-17.5] years) underwent EGD/pH-MII for surveillance purposes and 64 (3.0 [0.1-15.8] years) for symptom evaluation. Of the 41 patients who underwent surveillance EGD/pH-MII, 18 (43.9%) were asymptomatic when interviewed. Eight of these 18 (44.4%) had results that changed management decisions. In total, 23/41 (56.1%) had results that changed management decisions. Sixty-four patients presented clinically with (a combination of) dysphagia (n = 50; 78.1%), regurgitation (n = 37; 57.8%), heartburn (n = 18; 28.1%), and/or respiratory symptoms that were thought to have a gastrointestinal origin (n = 24; 37.5%). Results changed management decisions in 34/64 (53.1%) patients who presented with symptoms. There is a high clinical yield of EGD and pH-MII testing in EA patients. More than half of the patients, regardless of indication (routine surveillance or symptom evaluation), had EGD and/or pH-MII results that changed management decisions.
根据欧洲儿科胃肠病学、肝病学和营养学会以及北美儿科胃肠病学、肝病学和营养学会（ESPGHAN-NASPGHAN）指南，食管闭锁（EA）患者应常规接受食管胃十二指肠镜检查（EGD）并取活检和/或进行pH阻抗检测（pH多通道腔内阻抗测试；pH-MII）以进行监测。此外，当有临床指征时，建议进行这些检查：提示胃食管反流病或嗜酸性食管炎的症状。本研究的目的是评估EGD/pH-MII检查结果改变前来接受监测和/或症状临床评估的EA患儿管理决策的频率。对所有因常规监测或临床指征（即提示胃食管反流病或嗜酸性食管炎的症状）接受EGD和/或pH-MII检查的EA患者进行了回顾性病历审查。对于每一项检查，我们评估检查结果是否改变了管理决策。2017年至2020年期间，41例患者（中位年龄2.0[1.0 - 17.5]岁）接受EGD/pH-MII检查用于监测，64例患者（3.0[0.1 - 15.8]岁）接受检查用于症状评估。在接受监测性EGD/pH-MII检查的41例患者中，18例（43.9%）在接受访谈时无症状。这18例患者中有8例（44.4%）的检查结果改变了管理决策。总体而言，41例中有23例（56.1%）的检查结果改变了管理决策。64例患者临床上出现吞咽困难（n = 50；78.1%）、反流（n = 37；57.8%）、烧心（n = 18；28.1%）和/或被认为有胃肠道起源的呼吸道症状（n = 24；37.5%）（多种症状组合）。有症状的64例患者中，34例（53.1%）的检查结果改变了管理决策。EGD和pH-MII检查在EA患者中的临床获益率很高。超过一半的患者，无论检查指征是常规监测还是症状评估，其EGD和/或pH-MII检查结果都改变了管理决策。
