Classification of Esophageal Strictures following Esophageal Atresia Repair

Introduction  The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations. Materials and Methods  A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SI XR ) and endoscopically (SI END ). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis. Results  In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8–232.5, median: 97.6). The mean SI XR was 0.56 ± 0.16 (range: 0.15–0.86). The mean SI END was 0.45 ± 0.22 (range: 0.15–0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1–9). The number of dilations was poorly correlated with SI XR , while significantly correlated with SI END . Patients who did not need dilations had a SI END END END  ≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy. Conclusion  SI END is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SI END becomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.