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Oral Presentation - 5
Risk factors for gastroesophageal reflux in patients treated for type C esophageal atresia: a single-center retrospective study
Alberto Colesanti 1, Martina Ichino 1, Anna Morandi 1, Pietro Betalli 1, Giorgio Fava 1, Ernesto Leva 2
1 Department of pediatric surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
2 Pediatric Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
Purpose: Gastroesophageal reflux (GER) is a common complication in patients with esophageal atresia (EA). Factors associated with clinically significant GER remain unclear. We aimed to identify factors associated with the need for GER treatment in EA patients.
Methods: A retrospective review was conducted on patients treated for type C EA at our center between 2015 and 2023. Patients were divided into three groups based on treatment at last follow-up: Group 1 – no therapy, Group 2 – proton pump inhibitor (PPI) therapy, Group 3 – fundoplication. Perinatal data (gestational age, birth weight, prematurity), associated malformations, and surgical variables (multistage repair, stricture, anastomotic leak, recurrent fistula) were analyzed. Statistical analysis was performed using the t-test and Fisher’s exact test (p<0.05).
Results: 54 patients were included. Mean follow-up was 6.2 ± 2.2 years. At last follow-up, 28% of patients required treatment for GER (Groups 2+3). Compared to Group 1, these patients had lower gestational age (35.7 ± 2.7 vs. 37.2 ± 2.0 weeks; p=0.029), lower birth weight (2165 ± 637 vs. 2603 ± 571 g; p=0.018), higher association with VACTERL anomalies (47% vs. 13%; p=0.024), more frequent need for staged repair (47% vs. 8%; p=0.003), and higher incidence of esophageal stricture (47% vs. 11%; p=0.007). Compared to Group 2, patients in Group 3 were more frequently premature (100% vs. 44%; p=0.044), had more frequently a low birth weight (100% vs. 44%; p=0.044), and congenital heart defects (50% vs. 0%; p=0.044).
Conclusions: Prematurity, low birth weight, VACTERL anomalies, staged repair, and anastomotic stricture seem to be associated with clinically significant GER. Fundoplication is more frequently required in patients with a vulnerable perinatal profile and congenital heart disease. Identification of at-risk patients may guide follow-up and treatment strategies.