title: Anastomotic strictures and endoscopic dilatations following esophageal atresia repair.
abstract: OBJECTIVE
  To identify risk factors that can predict prevalence of anastomotic strictures (AS) following esophageal atresia (EA) repair.
  
  
  METHODS
  Of 46 consecutive patients with EA managed at our institution between 2004 and 2012, 35 underwent esophageal anastomosis and were included in this retrospective longitudinal study. Routine endoscopy was performed 1 month after surgical repair. According to stricture index (SI), endoscopically calculated as SI = (D - d)/D, where D is the diameter of the esophageal pouch and d the stricture diameter, population was divided into Group 1, SI ≤ 0.1 (no evidence of stricture); Group 2, 0.3 > SI > 0.1 (mild stricture); Group 3, SI ≥ 0.3 (high-grade stricture). Trends of subsequent endoscopic esophageal dilatations were compared between the groups using Wilcoxon-Mann-Whitney or Pearson's tests. Cox regression analysis was performed to estimate the hazard ratio.
  
  
  RESULTS
  Gastro-esophageal reflux disease (P = 0.04), tension on the anastomosis (P = 0.02) and long-gap form (P = 0.008) have an increased risk of developing AS. SI at 1 month after surgery correlates with the average number of future dilatations: Group 2 and 3 compared to Group 1 required more dilatations (hazard ratio 2.291 and 12.765).
  
  
  CONCLUSIONS
  AS remain frequent complications of esophageal surgery, especially in specific subgroups of patients. SI at 1 month after surgery could already predict the severity of the stricture and the need for subsequent endoscopic esophageal dilatations.
authors.affiliation: Department of Paediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Padiglione Alfieri (Chirurgia Pediatrica), Via Commenda, 10, 20122 Milan, Italy. parfil@hotmail.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Parolini
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.forename: Francesco
authors.initials: F
authors.lastname: Macchini
authors.forename: Valerio
authors.initials: V
authors.lastname: Gentilino
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Cesare
authors.forename: Maurizio
authors.initials: M
authors.lastname: Torricelli
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D004106:Dilatation / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome