An international survey on anastomotic stricture management after esophageal atresia repair: considerations and advisory statements

20 December 2020

Surgical endoscopy, 2020 Aug

Chantal A. ten Kate1 · Renato Tambucci2 · John Vlot1 · Manon C. W. Spaander3 · Frederic Gottrand4 · Rene M. H. Wijnen1 · Luigi Dall’Oglio2Received: 8 April 2020 / Accepted: 24 July 2020 © The Author(s) 2020


Endoscopic dilatation is the first-line treatment of stricture formation after esophageal atresia (EA) repair. However, there is no consensus on how to perform these dilatation procedures which may lead to a large variation between centers, countries and doctor’s experience. This is the first cross-sectional study to provide an overview on differences in endoscopic dilatation treatment of pediatric anastomotic strictures worldwide.
An online questionnaire was sent to members of five pediatric medical networks, experienced in treating anasto-motic strictures in children with EA. The main outcome was the difference in endoscopic dilatation procedures in various centers worldwide, including technical details, dilatation approach (routine or only in symptomatic patients), and adjuvant treatment options. Descriptive statistics were performed with SPSS.ResultsResponses from 115 centers from 32 countries worldwide were analyzed. The preferred approach was balloon dilatation (68%) with a guidewire (66%), performed by a pediatric gastroenterologist (n = 103) or pediatric surgeon (n = 48) in symptomatic patients (68%). In most centers, hydrostatic pressure was used for balloon dilatation. The insufflation dura-tion was standardized in 59 centers with a median duration of 60 (range 5–300) seconds. The preferred first-line adjunctive treatments in case of recurrent strictures were intralesional steroids and topical mitomycin C, in respectively 47% and 31% of the centers.
We found a large variation in stricture management in children with EA, which confirms the current lack of consensus. International networks for rare diseases are required for harmonizing and comparing the procedures, for which we give several suggestions.

Esophageal atresia · Anastomotic strictures · Dilatation management

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