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Eur J Pediatr Surg
DOI: 10.1055/a-2793-1101
Original Article

Evolving Surgical Practices in Esophageal Atresia: Insights from the EUPSA-ERNICA Survey a Decade After the 2014 Baseline Study

Authors

  • Tutku Soyer 

    1   Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey

  • Federica Pederiva

    2   Department of Pediatric Surgery, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

  • Luca Pio

    3   Pediatric Surgery Unit, Hôpitaux de Paris, Université Paris-Saclay, Paris, Île-de-France, France

  • Olivia K.C. Spivack 

    4   Department of Pediatric Surgery, Erasmus MC Sophia Children Hospital, Rotterdam, Netherlands

  • Igor Sukhotnik

    5   Department of Pediatric Surgery, Tel Aviv Sourasky Medical Center Ichilov, Tel Aviv, Israel

  • Fabian Doktor

    6   Department of Pediatric Surgery, University of Leipzig Faculty of Medicine, Leipzig, SN, Germany

  • Elke Zani-Ruttenstock

    7   Division of General and Thoracic Surgery, University of Washington School of Medicine, Seattle, Washington, United States

  • Ramon Gorter

    8   Department of Pediatric Surgery, Emma Childrens' Hospital UMC, Amsterdam, Noord-Holland, Netherlands

  • Jens Dingemann 

    9   Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany

  • Carmen Mesas-Burgos

    10   Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden

  • Rene Wijnen

    11   Department of Pediatric Surgery, Erasmus MC Sophia, Rotterdam, Netherlands

  • Nigel Hall

    12   Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Abstract

Objective

The European Paediatric Surgeons' Association (EUPSA) and the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) conducted a survey to assess the current surgical management and care practices for esophageal atresia (EA) in order to assess changes over the past decade.

Methods

An online survey consisting of 56 questions was administered to EUPSA members and ERNICA representatives between March and September 2025. The questionnaire covered seven domains: center structure, preoperative assessment, surgical management of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients and long-gap EA, postoperative care, long-term follow-up, and the management of complications. Results were compared to practices reported in a previous EUPSA Network Office survey in 2013.

Results

There were a total of 202 respondents from 41 countries with 60% from European Union countries. Compared with previous surveys, the routine use of preoperative bronchoscopy and the use of trans-anastomotic tubes were found to be significantly more common (both p < 0.001). A marked increase in preference for thoracoscopic techniques for EA-TEF was observed (p < 0.001). The routine use of chest drains, elective paralysis, and contrast studies prior to feeding initiation also rose significantly over the decade (p ≤ 0.004). Yet for many areas of care, there remains variation between surgeons, and structured long-term follow-up arrangements are not universal.

Conclusion

The findings demonstrate increased standardization and suggest increased adherence to recommendations in the management of EA-TEF. However, significant variation persists in long-term follow-up, transition-to-adult-care programs, and structured quality-of-life assessment, highlighting areas for future harmonization across European centers.

Keywords

esophageal atresia - tracheoesophageal fistula - survey - patient care - chest drain

Contributors' Statement

T.S.: conceptualization, data curation, writing—original draft, writing—review and editing; F.P.: conceptualization, formal analysis, writing—original draft, writing—review and editing; L.P.: data curation, formal analysis, methodology; O.K.C.S.: conceptualization, data curation, writing—review and editing; I.S.: conceptualization, data curation; F.D.: conceptualization, data curation; E.Z.-R.: conceptualization, data curation; R.G.: conceptualization, data curation; J.D.: conceptualization, data curation, writing—review and editing; C.M.-B.: conceptualization, data curation; R.W.: conceptualization, data curation; N.J.H.: conceptualization, data curation, writing—review and editing.


Supplementary Material



Publication History

Received: 10 January 2026

Accepted: 20 January 2026

Accepted Manuscript online:
23 January 2026

Article published online:
05 February 2026

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