Post-operative management of esophageal atresia-tracheoesophageal fistula and gastroesophageal reflux: a Canadian Association of Pediatric Surgeons annual meeting survey.
BACKGROUND
Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is commonly associated with gastroesophageal reflux (GER) after surgical repair. One risk factor for anastomotic stricture is post-operative GER. This survey assessed practice patterns among attendees at the Canadian Association of Pediatric Surgeons (CAPS) annual meeting with respect to management of GER post EA-TEF repair.


METHODS
A pre-piloted survey was handed out and collected at the 2012 CAPS annual meeting. Data were entered and coded, and descriptive statistics were calculated.


RESULTS
We distributed 70 surveys, and 57 (81.4%) surveys were returned. On average, the incidence of EA-TEF is 8-10 cases per institution, per year. Anti-reflux medication is started immediately post-operatively in 74% of patients at institution of feeds (11%), or if symptoms of reflux develop (14%). Proton pump inhibitors and H2-receptor antagonists are used in approximately equal proportion. Patients are typically kept on anti-reflux medication for 3-6 months (37%) or 6-12 months (35%).


CONCLUSIONS
Most CAPS attendees treat postoperative GER prophylactically. However, there is no consistency in management strategy regarding which anti-reflux agent to use or for how long. A multi-centered study is required to establish a standardized protocol for the post-operative management of EA-TEF to prevent reflux and its effect on anastomotic strictures.
McMaster Children's Hospital, Hamilton, Ontario, Canada L8N 3Z5.
Anna C
AC
Shawyer
McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
Julia
J
Pemberton
McMaster Children's Hospital, Hamilton, Ontario, Canada L8N 3Z5; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8N 3Z5. Electronic address: flageol@mcmaster.ca.
Helene
H
Flageole
D003430:Cross-Sectional Studies; D004750:Enteral Nutrition; D004933:Esophageal Atresia / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D019538:Health Care Surveys; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007440:Intubation; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
Esophageal atresia; Gastroesophageal reflux; Post-operative management; Tracheoesophageal fistula