ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

Carmen Dingemann; Simon Eaton; Gunnar Aksnes; Pietro Bagolan; Kate M. Cross; Paolo De Coppi; JoAnne Fruithof; Piergiorgio Gamba; Steffen Husby; Antti Koivusalo; Lars Rasmussen; Rony Sfeir; Graham Slater; Jan F. Svensson; David C. Van der Zee; Lucas M. Wessel; Anke Widenmann-Grolig; Rene Wijnen; Benno M. Ure

doi:10.1055/s-0039-1693116

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2020; 30(04): 326-336
DOI: 10.1055/s-0039-1693116

Original Article

Georg Thieme Verlag KG Stuttgart · New York

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

Carmen Dingemann

¹Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany

,

Simon Eaton

²Department of Paediatric Surgery and Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health, London, United Kingdom

,

Gunnar Aksnes

³Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway

,

Pietro Bagolan

⁴Department of Medical and Surgical Neonatology, Bambino Gesu Children's Research Hospital, Rome, Italy

,

Kate M. Cross

⁵Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom

,

Paolo De Coppi

²Department of Paediatric Surgery and Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health, London, United Kingdom

⁵Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom

,

JoAnne Fruithof

⁶Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and—VOKS, Lichtenvoorde, The Netherlands

,

Piergiorgio Gamba

⁷Department of Pediatric Surgery, University of Padua, Padua, Italy

,

Steffen Husby

⁸Department of Pediatric Gastroenterology, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark

,

Antti Koivusalo

⁹Department of Pediatric Surgery, University of Helsinki, Children's Hospital, Helsinki, Finland

,

Lars Rasmussen

¹⁰Department of Pediatric Surgery, Odense University hospital, Odense, Denmark

,

Rony Sfeir

¹¹Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France

,

Graham Slater

¹²Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and—TOFS, Nottingham, United Kingdom

,

Jan F. Svensson

¹³Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden

,

David C. Van der Zee

¹⁴Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

,

Lucas M. Wessel

¹⁵Department of Pediatric Surgery, University of Mannheim, Medical Faculty of Heidelberg, Mannheim, Germany

,

Anke Widenmann-Grolig

¹⁶Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and KEKS, Stuttgart, Germany

,

Rene Wijnen

¹⁷Department of Pediatric Surgery, Erasmus MC Sophia Ringgold standard institution, Rotterdam, The Netherlands

,

Benno M. Ure

¹Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany

› Author Affiliations

Abstract

Introduction Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature.

Materials and Methods Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9.

Results Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1–9). Eight of these (62%) did not reach consensus.

Conclusion Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

Keywords

esophageal atresia - European Reference Network on Rare Inherited and Congenital Anomalies (ERNICA) - surgical management - evidence - consensus conference

Full Text

References

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