Endoscopic Surveillance After Repair of Oesophageal Atresia: Longitudinal Study in 209 Patients.
OBJECTIVE
After repair of oesophageal atresia (OA), the need for endoscopic follow-up (EFU) remains unclear. To end this, we assessed the trends of oesophageal mucosal changes in successive follow-up biopsies.


METHODS
EFU records of 264 patients including histological grades of oesophagitis (from 0 to III), gastric (GM) or intestinal (IM) metaplasia and dysplasia (mild to severe) at 1, 3, 5 10, 15, and >15 years after repair of OA were reviewed.


RESULTS
Included were 209 patients with 616 biopsies. A total of 60 patients had undergone antireflux surgery and 24 had long-gap OA (LG). Median follow-up was 12 (range 1-17) years with 3 (1-6) endoscopies per patient. Highest grade of oesophagitis was Gr 0 (no oesophagitis) in 47%, Gr I in 37%, and Gr II or III in 16%. Metaplasia, GM (n = 31), IM (n = 4), occurred in 17% of patients and reached 15% prevalence by 15 years. Dysplasia and cancer were not found. From 1 to 15 years after repair grade of histological oesophagitis often fluctuated between Gr 0 and Gr I, but further progression was unlikely, hazard ratio = 0.2-3.4 (95% confidence interval 0.0-29), P = 0.06-0.87. LG and antireflux surgery predicted early detection of metaplasia (P < 0.001). Only 9% of patients with metaplasia and 32% with Gr II oesophagitis were symptomatic. A total of 6 (3%) patients had a symptomatic anastomotic stenosis at 1 year.


CONCLUSIONS
EFU revealed frequent oesophagitis and metaplasia, but no dysplasia or cancer. Routine endoscopic surveillance had limited benefit and seems unnecessary during childhood after repair of OA.
Children[Combining Acute Accent]s Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland.
Antti I
AI
Koivusalo
Mikko P
MP
Pakarinen
Harry G
HG
Lindahl
Risto J
RJ
Rintala
D001706:Biopsy; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal; D004933:Esophageal Atresia / Q000601:surgery*; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D000071041:Esophageal Mucosa / Q000473:pathology / Q000601:surgery*; D004941:Esophagitis / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008679:Metaplasia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D015995:Prevalence; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis