Background: Endoscopic dilatation is the first-line treatment of stricture formation after esophageal atresia (EA) repair. However, there is no consensus on how to perform these dilatation procedures which may lead to a large variation between centers, countries and doctor’s experience. This is the first cross-sectional study to provide an overview on differences in endoscopic dilatation treatment of pediatric anastomotic strictures worldwide. Methods: An online questionnaire was sent to members of five pediatric medical networks, experienced in treating anastomotic strictures in children with EA. The main outcome was the difference in endoscopic dilatation procedures in various centers worldwide, including technical details, dilatation approach (routine or only in symptomatic patients), and adjuvant treatment options. Descriptive statistics were performed with SPSS. Results: Responses from 115 centers from 32 countries worldwide were analyzed. The preferred approach was balloon dilatation (68%) with a guidewire (66%), performed by a pediatric gastroenterologist (n = 103) or pediatric surgeon (n = 48) in symptomatic patients (68%). In most centers, hydrostatic pressure was used for balloon dilatation. The insufflation duration was standardized in 59 centers with a median duration of 60 (range 5–300) seconds. The preferred first-line adjunctive treatments in case of recurrent strictures were intralesional steroids and topical mitomycin C, in respectively 47% and 31% of the centers. Conclusions: We found a large variation in stricture management in children with EA, which confirms the current lack of consensus. International networks for rare diseases are required for harmonizing and comparing the procedures, for which we give several suggestions.
Bibliographical noteThis survey was performed under the auspices of the European Reference Network on Rare Inherited and Congenital Anomalies. We thank Lana de Hoon, a student researcher, for her help conducting the online survey. We thank the European Society for Pediatric Gastroenterology, Hepatology and Nutrition Esophageal Atresia Working Group, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Australian Society of Paediatric Gastroenterology Hepatology and Nutrition, European Pediatric Surgeons? Association Network Office and International Network of Esophageal Atresia for their help with distributing the survey. Also, we thank all members of these associations who have taken the time to complete this survey. Finally, we thank Ko Hagoort, who provided editorial advice.
© 2020, The Author(s).