title: The Esophageal Anastomotic Stricture Index (EASI) for the management of esophageal atresia.
abstract: BACKGROUND
  Anastomotic stricture is the most common complication following repair of esophageal atresia. An Esophageal Anastomotic Stricture Index (EASI) based on the postoperative esophagram may identify patients at high risk of stricture formation.
  
  
  METHODS
  Digital images of early postoperative esophagrams of patients undergoing EA repair from 2005 to 2013 were assessed. Demographics and outcomes including dilations were prospectively collected. Upper (U-EASI) and lower (L-EASI) pouch ratios were generated using stricture diameter divided by maximal respective pouch diameter. Score performances were evaluated with area under the receiver operator curves (AUC) and the Fisher's exact test for single and multiple (>3) dilatations. Interrater agreement was evaluated using the intraclass correlation coefficient (ICC).
  
  
  RESULTS
  Forty-five patients had esophagrams analyzed; 28 (62%) required dilatation and 19 received >3 (42%). U-EASI and L-EASI ratios ranged from 0.17 to 0.70, with L-EASI outperforming the U-EASI as follows: L-EASI AUC: 0.66 for a single dilatation, 0.65 for >3 dilatations; U-EASI AUC: 0.56 for a single dilatation, 0.67 for >3 dilatations. All patients with an L-EASI ratio of ≤0.30 (n=8) required multiple esophageal dilatations, p=0.0006. The interrater ICC was 0.87.
  
  
  CONCLUSIONS
  The EASI is a simple, reproducible tool to predict the development and severity of anastomotic stricture after esophageal atresia repair and can direct postoperative surveillance.
authors.affiliation: McGill University, Montreal, QC, Canada.
authors.forename: Linda Yi-Chan
authors.initials: LY
authors.lastname: Sun
authors.affiliation: Division of Pediatric Surgery, Montreal Children's Hospital; Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.affiliation: McGill University, Montreal, QC, Canada.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Yousef
authors.affiliation: Division of Pediatric Surgery, Montreal Children's Hospital; Faculty of Medicine, McGill University, Montreal, QC, Canada. Electronic address: robert.baird@mail.mcgill.ca.
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D011859:Radiography
keywords: Anastomotic stricture; Esophageal atresia; Index; Prognostic tool