Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Usefulness of routine early œsophagogram after primary repair of œsophageal atresia: a multicenter study

Pediatric Research volume 94, pages 1779–1783 (2023)Cite this article

Abstract

Background

Advances in surgical and neonatal care have led to improved survival of patients with œsophageal atresia (OA) over time. Morbidity remains significant, with one-third of patients being affected by a postoperative complication. Several aspects of management are not consensual, such as the use of œsophagogram before starting oral feeding.

Methods

We conducted a multicenter retrospective study, including all children with OA that underwent a primary anastomosis in the first days of life, between 2012 and 2018 in five French centers, to determine the usefulness of postoperative œsophagogram during the 10 days after early primary repair of OA to diagnose the anastomotic leak and congenital œsophageal stenosis.

Results

Among 225 included children, 90 (40%) had a routine œsophagogram and 25 (11%) had an anastomotic leak, clinically diagnosed before the scheduled œsophagogram in 24/25 (96%) children at median postoperative day 4. Ten patients had associated congenital œsophageal stenosis diagnosed on the œsophagogram in only 30% of cases.

Conclusion

Early œsophagogram is rarely useful in the diagnosis of an anastomotic leak, which is clinically diagnosed before performing an œsophagogram in the majority of cases. The need for a postoperative œsophagogram should be evaluated on a case-by-case basis.

Impact

  • Early œsophagogram is not helpful in the diagnosis of an anastomotic leak in the majority of cases.

  • An anastomotic leak is most often diagnosed clinically before performing an œsophagogram.

  • Early postoperative œsophagogram could be helpful for the diagnosis of congenital œsophageal stenosis. However, dysphagia occurs later and early diagnosis of congenital œsophageal stenosis has no impact on the management and outcome of asymptomatic children.

  • Indication of postoperative œsophagogram has to be evaluated on a case-by-case basis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart.

Similar content being viewed by others

Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

References

  1. Pedersen, R. N., Calzolari, E., Husby, S. & Garne, E., EUROCAT Working group. Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch. Dis. Child. 97, 227–232 (2012).

    Article  PubMed  Google Scholar 

  2. Schneider, A. et al. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J. Rare Dis. 9, 206 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Allin, B., Knight, M., Johnson, P. & Burge, D., BAPS-CASS. Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS One 9, e106149 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dingemann, C. et al. ERNICA Consensus Conference on the management of patients with esophageal atresia and tracheoesophageal fistula: diagnostics, preoperative, operative, and postoperative management. Eur. J. Pediatr. Surg. 30, 326–336 (2020).

    Article  PubMed  Google Scholar 

  5. Yanchar, N. L., Gordon, R., Cooper, M., Dunlap, H. & Soucy, P. Significance of the clinical course and early upper gastrointestinal studies in predicting complications associated with repair of esophageal atresia. J. Pediatr. Surg. 36, 815–822 (2001).

    Article  CAS  PubMed  Google Scholar 

  6. Golden, J. et al. Routine post-operative esophagram Is not necessary after repair of esophageal atresia. Am. J. Surg. 213, 640–644 (2017).

    Article  PubMed  Google Scholar 

  7. Nambirajan, L., Rintala, R. J., Losty, P. D., Carty, H. & Lloyd, D. A. The value of early postoperative oesophagography following repair of oesophageal atresia. Pediatr. Surg. Int. 13, 76–78 (1998).

    Article  CAS  PubMed  Google Scholar 

  8. Donoso, F., Kassa, A.-M., Gustafson, E., Meurling, S. & Lilja, H. E. Outcome and management in infants with esophageal atresia – a single centre observational study. J. Pediatr. Surg. 51, 1421–1425 (2016).

    Article  PubMed  Google Scholar 

  9. Zani, A. et al. International survey on the management of esophageal atresia. Eur. J. Pediatr. Surg. 24, 3–8 (2014).

    Article  PubMed  Google Scholar 

  10. Lal, D., Miyano, G., Juang, D., Sharp, N. E. & St Peter, S. D. Current patterns of practice and technique in the repair of esophageal atresia and tracheoesophageal fistua: an IPEG survey. J. Laparoendosc. Adv. Surg. Tech. A 23, 635–638 (2013).

    Article  PubMed  Google Scholar 

  11. Ladd, W. E. & Swenson, O. Esophageal atresia and tracheo-esophageal fistula. Ann. Surg. 125, 23–40 (1947).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Roberts, K., Karpelowsky, J., Fitzgerald, D. A. & Soundappan, S. S. V. Radiation exposure in infants with oesophageal atresia and tracheo-oesophageal fistula. Pediatr. Surg. Int. 35, 509–515 (2019).

    Article  PubMed  Google Scholar 

  13. Crapnell, T. et al. Factors associated with infant feeding difficulties in the very preterm infant. Acta Paediatr. 102, e539–e545 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Pickler, R. H. et al. Effects of the neonatal intensive care unit environment on preterm infant oral feeding. Res. Rep. Neonatol. 2013, 15–20 (2013).

    PubMed  PubMed Central  Google Scholar 

  15. McCann, F. et al. Congenital esophageal stenosis associated with esophageal atresia. Dis. Esophagus. 28, 211–215 (2015).

    Article  CAS  PubMed  Google Scholar 

  16. Braungart, S., Peters, R. T., Lansdale, N. & Wilkinson, D. J. Congenital oesophageal stenosis in oesophageal atresia: underrecognised and often missed? Pediatr. Surg. Int. 38, 331–335 (2022).

    Article  PubMed  Google Scholar 

  17. Yousef, Y. & Baird, R. Radiation exposure and attributable cancer risk in patients with esophageal atresia. J. Pediatr. Gastroenterol. Nutr. 66, 234–238 (2018).

    Article  PubMed  Google Scholar 

  18. Chapple, C. L., Faulkner, K. & Hunter, E. W. Energy imparted to neonates during X-ray examinations in a special care baby unit. Br. J. Radiol. 67, 366–370 (1994).

    Article  CAS  PubMed  Google Scholar 

  19. Pham, A. et al. Feeding disorders in children with oesophageal atresia: a cross-sectional study. Arch. Dis. Child. 107, 52–58 (2022).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all of the children and their families who participated in this study.

Author information

Authors and Affiliations

  1. Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Neonatal Medicine, 75012, Paris, France

    Aurélie Pham

  2. Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of Pediatric Radiology, 75012, Paris, France

    Lynn Ezzeddine & Hubert Ducou Le Pointe

  3. Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Department of Pediatric General Surgery and Urology, 75019, Paris, France

    Arnaud Bonnard & Louise Montalva

  4. Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Neonatal Intensive Care Unit, 75015, Paris, France

    Alexandre Lapillonne

  5. Paris-Cité University, Assistance publique des hôpitaux de Paris, Necker-Enfants Malades University Hospital, Department of Pediatric Surgery, 75015, Paris, France

    Véronique Rousseau

  6. Paris-Cité University, Assistance publique des hôpitaux de Paris, Robert-Debré University Hospital, Neonatal Intensive care unit, 75019, Paris, France

    Nizar Khattat

  7. Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Intensive neonatal and pediatric care unit, 75012, Paris, France

    Julia Guilbert

  8. Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Neonatal Intensive care unit, 94250, Le Kremlin Bicêtre, France

    Mostafa Mokhtari

  9. Paris Saclay University, Assistance publique des hôpitaux de Paris, Kremlin Bicêtre Hospital, Department of Pediatric Surgery, 94250, Le Kremlin Bicêtre, France

    Virginie Fouquet

  10. Centre hospitalier intercommunal de Créteil, Department of Pediatric Surgery, 94300, Créteil, France

    Olivier Jaby

  11. Centre hospitalier intercommunal de Créteil, Neonatal Intensive Care Unit, 94300, Créteil, France

    Fabrice Decobert

  12. François Rabelais University, CHRU de Tours, Bretonneau Hospital, Neonatal Intensive Care Unit, 37000, Tours, France

    Delphine Mitanchez

  13. Sorbonne University, Assistance publique des hôpitaux de Paris, Armand Trousseau Hospital, Department of visceral and neonatal pediatric surgery, 75012, Paris, France

    Sabine Irtan

Authors
  1. Aurélie Pham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynn Ezzeddine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arnaud Bonnard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandre Lapillonne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Véronique Rousseau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Louise Montalva
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nizar Khattat
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Julia Guilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mostafa Mokhtari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Virginie Fouquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Olivier Jaby
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Fabrice Decobert
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Delphine Mitanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hubert Ducou Le Pointe
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Sabine Irtan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AP: conception of the work, acquisition, analysis and interpretation of data; drafting the work; final approval of the version published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SI, DM, HDLP: conception of the work, acquisition, analysis and interpretation of data; revising the work critically for important intellectual content; and final approval of the version published. LE, AB, AL, LM, VR, NK, JG, MM, VF, OJ, FD: contribution to the acquisition of data; revising the work critically for important intellectual content; and final approval of the version published.

Corresponding author

Correspondence to Aurélie Pham.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study received CER_SFP (Comité d’éthique de la recherche de la Société Française de Pédiatrie) approval on November 16, 2020 (CER_SFP_2020_116_V2), has been registered with CNIL (the French Data Protection Authority) and was done in accordance with French guidelines and regulations. Consent was obtained from the parents of included children.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pham, A., Ezzeddine, L., Bonnard, A. et al. Usefulness of routine early œsophagogram after primary repair of œsophageal atresia: a multicenter study. Pediatr Res 94, 1779–1783 (2023). https://doi.org/10.1038/s41390-023-02696-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-023-02696-x

Search

Advanced search

Quick links