Outcome of long gap esophageal atresia at 6 years: A prospective case control cohort study

• Published in: Journal of pediatric surgery Vol. 58; no. 4; pp. 747 - 755
• Main Authors: Bourg, Agate, Gottrand, Frédéric, Parmentier, Benoit, Thomas, Julie, Lehn, Anne, Piolat, Christian, Bonnard, Arnaud, Sfeir, Rony, Lienard, Julie, Rousseau, Véronique, Pouzac, Myriam, Liard, Agnès, Buisson, Philippe, Haffreingue, Aurore, David, Louis, Branchereau, Sophie, Carcauzon, Véronique, Kalfa, Nicolas, Leclair, Marc-David, Lardy, Hubert, Irtan, Sabine, Varlet, François, Gelas, Thomas, Potop, Diana, Auger-Hunault, Marie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2023; American Academy of Pediatrics
• Series: Journal of Pediatric Surgery
• Subjects: Case-Control Studies; Child; Child, Preschool; Complications; Dysphagia; Esophageal atresia; Esophageal Atresia - complications; Esophageal replacement; Gastro-esophageal reflux disease; Humans; Infant; Infant, Newborn; Life Sciences; Long gap esophageal atresia; Midterm outcomes; Prospective Studies; Retrospective Studies; Tracheoesophageal Fistula - complications; Tracheoesophageal Fistula - epidemiology; Tracheoesophageal Fistula - surgery; Treatment Outcome; Gastro-esophageal reflux disease; Complications; Esophageal atresia; Midterm outcomes; Dysphagia; Long gap esophageal atresia; Esophageal replacement
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.07.023

EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years.
A multicentric population-based prospective study was performed and included all patients who underwent EA surgery in France from January 1, 2008 to December 31, 2010. A comparative study was performed with non-long gap EA/TEF patients. Morbidity at birth, 1 year, and 6 years was assessed.
Thirty-one patients with long gap EA were compared with 62 non-long gap EA/TEF patients. At age 1 year, the long gap EA group had longer parenteral nutrition support and longer hospital stay and were significantly more likely to have complications both early post-operatively and before age 1 year compared with the non-long gap EA/TEF group. At 6 years, digestive complications were more frequent in long gap compared to non-long gap EA/TEF patients. Tracheomalacia was the only respiratory complication that differed between the groups. Spine deformation was less frequent in the long gap group. There were no differences between conservative and replacement groups at ages 1 and 6 years except feeding difficulties that were more common in the native esophagus group.
Long gap strongly influenced digestive morbidity at age 6 years.