Clinical Characteristics and Treatment of Esophageal Atresia: A Single Institutional Experience
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 8
Abstract
Esophageal atresia (EA) is a congenital anomaly that affects approximately 1 in 2500–4000 live births. Available methods of improving the prenatal diagnostic rate include ultrasound examination of the fetal neck to view the blind-ending upper pouch and to observe fetal swallowing and magnetic resonance imaging. The newborn infant of a mother with polyhydramnios should always have a nasogastric tube passed soon after delivery to exclude esophageal atresia. While the management of EA and TEF has evolved over the last four decades, it continues to remain a challenging problem in specialized pediatric centers and even more so beyond such environments. Patients who had been admitted in Mahatma Gandhi Medical College, Jaipur with a diagnosis of esophageal atresia / tracheoesophageal fistula between September 2013 to March 2018 were enrolled. Patient’s data included medical record number (MRN), sex, date of birth, time of presentation, age at surgery(days), birth weight, gestational age, antenatal scan, mode of delivery, intra-operative measurements of gap, associated anomalies, postoperative morbidities and mortality ,time to discharge, follow up outdoor visits record. The outcomes measured included time from birth to operation, gap between the two ends, trans-anastomotic tube usage, pleural wrap, anastomotic leak rates, recurrence rates, presence of. Antenatal diagnosis based on antenatal scan was done in 4(16%) cases. 3 in in-born and 1 in out-born patients. Maternal Polyhydramnios was present in 6(24%) patients. The most common associated congenital malformation were cardiac 7(28%) followed by genitourinary 3(12%). Birth weight and cardiac anomalies were the most important prognostic markers. The survival in patients with birth weight more than 1.5 kg with no major cardiac anomalies was 93%. In patients with less than 1.5kg weight or major cardiac anomalies the survival was 77%. While one patient, weighing less than 1.5kg with major cardiac anomalies could not be salvaged. Another important prognostic marker was gap between the two ends of the esophagus, while patients with <2cms gap had subsequent stricture in 29.4 % compared to 50% in patients with >2cms gap. Patients with shorter than 2cms gap had no anastomotic leak compared to 25% leak in patients with >2cms gap. In long term, Tracheomalacia anastomotic stricture and pneumonia were the most common complications-Stricture, respiratory morbidity.
Authors and Affiliations
Dr. Siddharth Singh Rathore, Dr. Samta Bali Rathore
Keywords
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