DOZ047.114: Fundoplications in patients born with esophageal atresia: preoperative workup and evaluation of postoperative symptoms
Abstract
The consensus esophageal atresia (EA) guideline recommends performing contrast esophagogram, esophagogastroduodenoscopy with biopsies and pH(+ /-impedance) measurement prior to fundoplication to assess upper gastrointestinal anatomy, severity of gastroesophageal reflux disease (GERD), and exclude eosinophilic esophagitis (EoE).(Krishnan et al. JPGN 2016) Our aim was to evaluate which of these investigations were performed prior to fundoplication and which in case of postoperative symptoms.
In this multicenter international retrospective cohort study, all EA patients who underwent fundoplication between 2006 and 2017 were included.
Forty EA patients (52% male, median age 2.3 years [0.08–17 years], 82.5% type C) were included in three centers worldwide; 32(80%) underwent complete and 8 (20%) partial fundoplication. Preoperative investigations included contrast esophagogram (n = 35, 88%), esophagogastroduodenoscopy (n = 33, 83%), and pH(+/-impedance) measurement (n = 11, 28%). Only six patients (15%) underwent all three recommended preoperative investigations. Esophagogastroduodenoscopy prefundoplication revealed abnormalities in 33%, including esophageal strictures in 18%, EoE in 6%, hiatal hernia in 6%, and intestinal metaplasia in 3%. Patients with EoE underwent partial fundoplication; no associations between diagnostic testing outcomes and type of fundoplication were found. Nearly all patients had symptoms postfundoplication (n = 34, 85%). Symptoms included dysphagia (53%),…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 35 participants or records.
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