Gastro-Esophageal Reflux in Esophageal Atresia Patients Remains a Challenge: Results from a Systematic Review and Meta-Analysis

Alexander Sterlin; Hanna Garnier; Gabriela Vallejo; Joana M. Monteiro; Julio C. Moreno-Alfonso; Hilmican Ulman; Giovanna Riccipetitoni; Marta Gazzaneo

doi:10.1055/a-2767-4535

European Journal of Pediatric Surgery, Inhaltsverzeichnis

Eur J Pediatr Surg
DOI: 10.1055/a-2767-4535

Original Article

Gastro-Esophageal Reflux in Esophageal Atresia Patients Remains a Challenge: Results from a Systematic Review and Meta-Analysis

Autor*innen

Alexander Sterlin

¹Department of Pediatric Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany

²Department of Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
Hanna Garnier

³Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland

⁴Department of Pediatric Surgery, Public Assistance Hospitals, Paris University Paris Saclay, Le Kremlin-Bicêtre, Île-de-France, France
Gabriela Vallejo

⁵Department of Pediatrics, ISMETT, Palermo, Sicily, Italy

⁶Department of Pediatric Surgery, University of Messina Faculty of Medicine and Surgery, Messina, Sicily, Italy
Joana M. Monteiro

⁷Department of Plastic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
Julio C. Moreno-Alfonso

⁸Department of Pediatric Surgery, Navarre Hospital Complex, Pamplona, Navarre, Spain
Hilmican Ulman

⁹Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
Giovanna Riccipetitoni

¹⁰Department of Diagnostic and Pediatric Science, University of Pavia Faculty of Medicine and Surgery, Pavia, Lombardia, Italy
Marta Gazzaneo

²Department of Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom

¹¹Department of Pediatric Surgery, University of Brescia, Brescia, Lombardy, Italy

Abstract

Objective

Although international guidelines address the management of esophageal atresia (EA), the optimal approach to gastroesophageal reflux disease (GERD) in this population remains controversial. This systematic review and meta-analysis aims to clarify the current management of GERD in children after EA repair, reporting the prevalence of GERD, indications, and effectiveness of medical and surgical therapies.

Methods

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A literature search was performed in MEDLINE, Cochrane Database, and Web of Science. Studies involving patients under 18 years old with GERD following EA repair were included. Data were extracted on incidence, diagnostic approach, medical and surgical management, and outcomes.

Results

Out of 1,612 articles, 49 (5,613 patients) were included. Reporting diagnostic modality, pH-impedance was most frequently used. The pooled GERD incidence was 36.7% overall and 58.1% in type A/B EA. Postoperative anti-reflux medication was reported in 88% of patients; 53.8% of children receiving medical therapy subsequently required further procedures (anti-reflux surgery [ARS], feeding stoma, or total esophago-gastric dissociation). ARS was more common in type A/B than in type C/D cohorts. Resolution of symptoms after ARS was reported in 74.5% of patients. Complications following ARS occurred in 28.3%, with a 14.9% rate of redo fundoplication, and the highest incidence occurred in infants < 6 months. The data on timing and type of ARS were heterogeneous.

Conclusion

GERD affected over one-third of EA patients, with higher prevalence in types A and B. Although proton pump inhibitor therapy is common, a large proportion required ARS, with higher complication rates in smaller children. These findings highlight the need for standardized diagnostic criteria and multicenter prospective registries with long-term follow-up to clarify optimal timing and technique.

Keywords

EA - gastroesophageal reflux - pediatric surgery - systematic review - ARS

Volltext

Referenzen

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