DOZ047.114: Fundoplications in patients born with esophageal atresia: preoperative workup and evaluation of postoperative symptoms. (24th June 2019)

• Record Type: Journal Article
• Authors: van Lennep, M; Krishnan, U; Saoji, R; van Wijk, M P
• Is Part Of: Diseases of the esophagus. Volume 32(2019)Supplement 1
• Publication Date: 2019-06-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doz047.114
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background: 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. Methods: In this multicenter international retrospective cohort study, all EA patients who underwent fundoplication between 2006 and 2017 were included. Results: 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%), gagging (33%), oral food aversion (23%), bloating (8%), and/or dumping (3%). Recurrent GERD symptoms were present in 34 patients (85%). Twenty-one patients (53%) had pH(+/-impedance) tests performed, which were abnormal in 14 patients (67%). Thirty-five patients (88%) also had EGD performed, which showed abnormalities in 5 patients (13%), of which 3 patients (8%) had strictures on EGD. One of these patients with postoperative strictures had EoE (3%). Abnormalities of 2 other patients on EGD were not further specified. Conclusion: Preoperative diagnostic workup for fundoplication in EA patients varies greatly. Although the majority of patients had some preoperative evaluation, only 15% underwent all gastrointestinal diagnostic tests that are currently advocated by the consensus EA guidelines. Postoperatively, most patients (85%) had symptoms for which testing was indicated. A large percentage still had evidence of GERD. More research is needed to tailor (surgical) management of GERD in EA patients, develop a postoperative testing paradigm, and evaluate the efficacy and safety of fundoplication in this specific patient group.