title: Classification of Esophageal Strictures following Esophageal Atresia Repair.
abstract: BACKGROUND
  The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations.
  
  
  METHODS
  A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SIXR) and endoscopically (SIEND). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis.
  
  
  RESULTS
  In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8-232.5, median: 97.6). The mean SIXRwas 0.56 ± 0.16 (range: 0.15-0.86). The mean SIENDwas 0.45 ± 0.22 (range: 0.15-0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1-9). The number of dilations was poorly correlated with SIXR, while significantly correlated with SIEND. Patients who did not need dilations had a SIEND< 0.33, patients who needed only one dilation had 0.33 ≤ SIEND< 0.44, and those with SIEND≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy.
  
  
  CONCLUSIONS
  SIENDis a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SIENDbecomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Macchini
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parente
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Farris
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Gentilino
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
mesh_terms: D004106:Dilatation; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000145:classification* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome