Abstract
Introduction The aim of this study was to stratify anastomotic strictures (AS) following esophageal
atresia (EA) repair and to establish predictors for the need of dilations.
Materials and Methods A retrospective study on children operated on for EA between 2004 and 2014 was conducted.
The stricture index (SI) was measured both radiologically (SIXR) and endoscopically (SIEND). A correlation analysis between the SI and the number of dilations was performed
using Spearman's test and linear regression analysis.
Results In this study, 40 patients were included: 35 (87.5%) presented with Gross's type
C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time
was 101 ± 71.1 months (range: 7.8–232.5, median: 97.6). The mean SIXR was 0.56 ± 0.16 (range: 0.15–0.86). The mean SIEND was 0.45 ± 0.22 (range: 0.15–0.85). Twenty-four patients (60%) underwent a mean of
2 endoscopic dilations (range: 1–9). The number of dilations was poorly correlated
with SIXR, while significantly correlated with SIEND. Patients who did not need dilations had a SIEND < 0.33, patients who needed only one dilation had 0.33 ≤ SIEND < 0.44, and those with SIEND ≥ 0.44 needed two or more dilations. No significant association with other clinical
variables was found. All patients were asymptomatic at the time of the first endoscopy.
Conclusion SIEND is a useful tool to classify AS and can represent a predictor of the need for endoscopic
dilation. The role of the SIEND becomes even more important as clinical characteristics have a low predictive value
for the development of an AS and the need for subsequent endoscopic esophageal dilatations.
Keywords
anastomotic stricture - esophageal dilation - esophageal atresia - stricture index
- infant
