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Long-term evolution of the children operated for esophageal atresia (EA)

R. Sfeir, C. Legrand-Brogniart, L. Michaud, M. Bonnevalle, F. Gottrand, R. Besson

Reference Centers for Congenital and Malformative Esophageal Affections, Children Hospital, Jeanne de Flandre Hospital and Faculty of Medicine, Lille, France

 

ABSTRACT

Introduction: Long-term evolution of the children operated for esophageal atresia is not well known. The goal of this work is to evaluate the future and the quality of life of the children operated for EA with a follow-up of at least 9 years.

Material and methods: 103 patients were operated for EA between 1989 and 1998. The children were reexamined to evaluate their nutritional status, their digestive, respiratory and orthopedic symptoms, their quality of life (PedsQL 4.0 questionnaire) and the respiratory function by spirometry (PFTs).

Results: 63 children were reexamined, 10 had died and 30 were not included (7 refused, 23 lost to follow-up). The average follow-up was 13, 4 years; 45% had anastomotic stenosis and 35% had a Nissen fundoplication; 73% had a normal nutritional status (obese: 16% ; malnutrition: 11%). Only 13% did not have digestive symptoms (dysphagia: 65%, GER: 35 %). The respiratory symptoms (52%) were: chronic cough (19%) and effort dyspnoea and/or cough (33%). The PFTs (36 patients) revealed proximal obstruction and/or pulmonary distension (50%) and a restrictive syndrome (11%). Vertebral static disorders were frequent (49%). The quality of life was good but poorer than that the quality of life of the control children (80/100 versus 84/100, p< 0, 05), poorer in case of associated cardiac malformation (p=0,01) or of respiratory symptoms (p=0,04).

Conclusion: The frequency and the variety of the delayed sequelae in the EA justify a multidisciplinary and prolonged follow-up.

 

Key words: esophageal atresia, anastomotic stenosis, Nissen fundoplication