PMID- 27769086
OWN - NLM
STAT- MEDLINE
DCOM- 20170705
LR  - 20220317
IS  - 1439-359X (Electronic)
IS  - 0939-7248 (Linking)
VI  - 27
IP  - 1
DP  - 2017 Feb
TI  - Risk Factors for Anastomotic Strictures after Esophageal Atresia Repair: 
      Prophylactic Proton Pump Inhibitors Do Not Reduce the Incidence of Strictures.
PG  - 50-55
LID - 10.1055/s-0036-1593607 [doi]
AB  - Background Since 2005, infants with esophageal atresia (EA) in our unit are given 
      prophylactic proton pump inhibitors (PPI) after repair until 1 year of age. The 
      aims of this study were to identify risk factors for anastomotic strictures (AS) 
      and to assess the efficacy of postoperative PPI prophylaxis in reducing the 
      incidence of AS compared with symptomatic PPI. Methods Patients who underwent EA 
      repair from 1994 to 2013 in our unit were included in this retrospective 
      observational study approved by the local ethics review board. They were divided 
      into two subgroups; symptomatic PPI-group with EA repair from 1994 to 2004 and 
      prophylactic PPI-group with EA repair from 2005 to 2013. Data were collected from 
      the patient records. Potential risk factors for AS analyzed were gender, long gap 
      EA, birth weight, premature birth (<37 gestational weeks), anastomotic tension, 
      and anastomotic leakage. Number of dilatations until the age of 1 and 5 years 
      were recorded. To evaluate risk factors for AS and the effect of prophylactic PPI 
      Logistic, Cox and Poisson regression models were used. For descriptive statistics 
      Fisher exact test and Wilcoxon rank sum test were used. Results A total of 128 
      patients were included. Patient characteristics, surgical method, grading of 
      anastomotic tension, complications, and survival rates did not differ 
      significantly between the symptomatic PPI-group (n = 71) and the prophylactic 
      PPI-group (n = 57). Comparing the symptomatic and prophylactic PPI-group, there 
      was no significant difference in the median age at the first AS (9.3 vs 6 mo), 
      the number of dilatations until 1 year (2 vs 2) and 5 years (5 vs 4), or the 
      incidence of anastomotic stricture (56.5% vs 50.9%). Long gap EA, high birth 
      weight, and anastomotic tension were found to be independent risk factors. 
      Conclusion Surgeons should aim to perform anastomosis under less tension at EA 
      repair. Prophylactic PPI-treatment does not appear to reduce the rate of AS. 
      Randomized controlled trials with larger study populations are needed to further 
      evaluate the efficacy of prophylactic PPI.
CI  - Georg Thieme Verlag KG Stuttgart . New York.
FAU - Donoso, Felipe
AU  - Donoso F
AD  - Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
FAU - Lilja, Helene Engstrand
AU  - Lilja HE
AD  - Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20161021
PL  - United States
TA  - Eur J Pediatr Surg
JT  - European journal of pediatric surgery : official journal of Austrian Association 
      of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
JID - 9105263
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Anastomosis, Surgical
MH  - Esophageal Atresia/*surgery
MH  - Esophageal Stenosis/epidemiology/*etiology/prevention & control
MH  - Esophagus/surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Postoperative Care/*methods
MH  - Postoperative Complications/epidemiology/*etiology/prevention & control
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2016/10/22 06:00
MHDA- 2017/07/06 06:00
CRDT- 2016/10/22 06:00
PHST- 2016/10/22 06:00 [pubmed]
PHST- 2017/07/06 06:00 [medline]
PHST- 2016/10/22 06:00 [entrez]
AID - 10.1055/s-0036-1593607 [doi]
PST - ppublish
SO  - Eur J Pediatr Surg. 2017 Feb;27(1):50-55. doi: 10.1055/s-0036-1593607. Epub 2016 
      Oct 21.