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DOI: 10.1055/s-0041-1739415
Esophageal Interventions in Infants Born with Esophageal Atresia: A Comprehensive Analysis of a National Database
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Abstract
Introduction Esophageal atresia (EA) is a rare malformation that often requires a series of procedures, including surgical primary anastomosis, staged repair, and endoscopic procedures. Actual numbers and trends in interventions and variety in treatment strategies remain unclear.
Materials and Methods Data from the German federal bureau of statistics containing all EA-related inpatient procedures encoded from 2005 until 2018 were analyzed for children during the first year of life. The sum of esophageal anastomoses and replacements was used to calculate an estimate of incidence of EA.
Results Over 14 years, 12,627,888 inpatient cases were recorded in infants in Germany. The mean incidence of EA was 1 per 4,217 live births. On average, 163.3 (95% confidence interval [CI]: 150.8–176.1) esophageal anastomoses, 11.2 (95% CI: 8.7–13.7) esophageal lengthening procedures, and 6.7 (95% CI: 5.42–8.00) esophageal replacements were recorded annually. Overall, 187.8 (95% CI: 147.1–200.4) endoluminal treatments (ballon dilatation, bougienage, stent placement, or injection) were performed per 100 anastomoses. Over the years, bougienage was increasingly replaced by ballon dilatation as primary treatment. Boys had a significantly higher number of esophageal procedures than girls, but the incidence of endoscopic treatments in relation to anastomoses was the same for both genders.
Conclusion The low incidence of EA in relation to a relatively large number of units treating those patients in Germany may pose challenges for maintaining competency and training of all specialists involved. The number of esophagoscopic treatments for esophageal stricture per anastomosis is lower than previously estimated.
Keywords
esophageal malformation - esophageal anastomosis - esophageal lengthening procedure - esophageal replacement - esophageal dilatationPublication History
Received: 17 June 2021
Accepted: 06 September 2021
Article published online:
10 December 2021
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References
- 1 Dingemann C, Eaton S, Aksnes G. et al. ERNICA consensus conference on the management of patients with esophageal atresia and tracheoesophageal fistula: diagnostics, preoperative, operative, and postoperative management. Eur J Pediatr Surg 2020; 30 (04) 326-336
- 2 Dingemann C, Eaton S, Aksnes G. et al. ERNICA consensus conference on the management of patients with esophageal atresia and tracheoesophageal fistula: follow-up and framework. Eur J Pediatr Surg 2020; 30 (06) 475-482
- 3 Baird R, Lal DR, Ricca RL. et al. Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA outcomes and evidence based practice committee. J Pediatr Surg 2019; 54 (04) 675-687
- 4 Dingemann C, Eaton S, Aksnes G, Bagolan P, Cross KM, De Coppi P. et al. ERNICA consensus conference on the management of patients with long-gap esophageal atresia: perioperative, surgical, and long-term management. Eur J Pediatr Surg 2021; 31 (03) 214-225
- 5 Krishnan U, Mousa H, Dall'Oglio L. et al. ESPGHAN-NASPGHAN guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with esophageal atresia-tracheoesophageal fistula. J Pediatr Gastroenterol Nutr 2016; 63 (05) 550-570
- 6 DESTATIS. Die Datenbank des Statistischen Bundesamtes. Accessed 27.08.2020 at: www-genesis.destatis.de/genesis//online?operation=table&code=12612–0001&bypass=true&levelindex=1&levelid=1598527044822#abreadcrumb
- 7 Schmedding A, Rolle U. Decentralized rather than centralized pediatric surgery care in Germany. Eur J Pediatr Surg 2017; 27 (05) 399-406
- 8 Schneider A, Blanc S, Bonnard A. et al. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J Rare Dis 2014; 9: 206
- 9 Dingemann C, Dietrich J, Zeidler J. et al. Early complications after esophageal atresia repair: analysis of a German health insurance database covering a population of 8 million. Dis Esophagus 2016; 29 (07) 780-786
- 10 Foker JE, Kendall TC, Catton K. et al. A flexible approach to achieve a true primary repair for all infants with esophageal atresia. Sem Ped Surg 2005; 14 (01) 8-15
- 11 Tambucci R, Angelino G, De Angelis P. et al. Anastomotic strictures after esophageal atresia repair: incidence, investigations, and management, including treatment of refractory and recurrent strictures. Front Pediatr 2017; 5: 120
- 12 Lazow SP, Ben-Ishay O, Aribindi VK. et al. Predictors of index admission mortality and morbidity in contemporary esophageal atresia patients. J Pediatr Surg 2020; 55 (11) 2322-2328
- 13 Black AJ, Lu DY, Yefet LS, Baird R. Sex differences in surgically correctable congenital anomalies: a systematic review. J Pediatr Surg 2020; 55 (05) 811-820
- 14 Teimourian A, Donoso F, Stenström P. et al. Gender and birth weight as risk factors for anastomotic stricture after esophageal atresia repair: a systematic review and meta-analysis. BMC Pediatr 2020; 20 (01) 400
- 15 Kulshrestha S, Kulshrestha M, Tewari V. et al. Conservative management of major anastomotic leaks occurring after primary repair in esophageal atresia with fistula: role of extrapleural approach. J Indian Assoc Pediatr Surg 2020; 25 (03) 155-162