Acid suppression duration does not alter anastomotic stricture rates after esophageal atresia with distal tracheoesophageal fistula repair: A prospective multi-institutional cohort study

• Published in: Journal of pediatric surgery 2022-06, Vol.57 (6), p.975-980
• Main Authors: Bowder, Alexis N, Bence, Christina M., Rymeski, Beth A, Gadepalli, Samir K., Sato, Thomas T., Szabo, Aniko, Arendonk, Kyle Van, Minneci, Peter C., Downard, Cynthia D., Hirschl, Ronald B., Markel, Troy, Courtney, Cathleen M., Deans, Katherine J., Fallat, Mary E., Fraser, Jason D., Grabowski, Julia E., Helmrath, Michael A., Kabre, Rashmi D., Kohler, Jonathan E., Landman, Matthew P., Lawrence, Amy E., Leys, Charles M., Mak, Grace, Port, Elissa, Saito, Jacqueline, Silverberg, Jared, Slidell, Mark B., St Peter, Shawn D., Troutt, Misty, Wright, Tiffany N., Lal, Dave R.
• Format: Article
• Language: English
• Subjects: Acid suppression; Anastomosis, Surgical - adverse effects; Anastomotic stricture; Cohort Studies; Constriction, Pathologic - etiology; Constriction, Pathologic - prevention & control; Esophageal atresia; Esophageal Atresia - complications; Esophageal Atresia - surgery; Esophageal Stenosis - epidemiology; Esophageal Stenosis - etiology; Esophageal Stenosis - prevention & control; Humans; Infant; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Prospective Studies; Retrospective Studies; Tracheoesophageal fistula; Tracheoesophageal Fistula - complications; Tracheoesophageal Fistula - surgery; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.02.004

Anastomotic stricture is the most common complication after esophageal atresia (EA) repair. We sought to determine if postoperative acid suppression is associated with reduced stricture formation. A prospective, multi-institutional cohort study of infants undergoing primary EA repair from 2016 to 2020 was performed. Landmark analysis and multivariate Cox regression were used to explore if initial duration of acid suppression was associated with stricture formation at hospital discharge (DC), 3-, 6-, and 9-months postoperatively. Of 156 patients, 79 (51%) developed strictures and 60 (76%) strictures occurred within three months following repair. Acid suppression was used in 141 patients (90%). Landmark analysis showed acid suppression was not associated with reduction in initial stricture formation at DC, 3-, 6- and 9-months, respectively (p = 0.19–0.95). Multivariate regression demonstrated use of a transanastomotic tube was significantly associated with stricture formation at DC (Hazard Ratio (HR) = 2.21 (95% CI 1.24–3.95, p