technetium-tc-99m-sulfur-colloid and Esophageal-Atresia

Current approaches to the repair of long-gap esophageal atresia (EA) favor esophageal anastomosis. This investigation provides a midterm follow-up of long-gap EA with a primary repair to determine whether this procedure affects symptom severity and whether symptom severity may predict worsening of dysmotility. Fifteen children at least 1-year post primary repair were divided into group 1 (long-gap) and group 2 (non-long-gap). The severity of their symptoms was graded using a questionnaire focused on their eating habits and gastroesophageal motor dysfunction symptoms. Esophageal transit time and gastric emptying were assessed by scintigraphy and used to grade esophagogastric dysmotility. At midterm follow-up the majority of patients in both groups were asymptomatic (66% in group 1 vs 77.7% in group 2; P > 0.05). Esophagogastric dysmotility grades for group 1 were more severe than for group 2 (median 2.5, range from 1 to 4 vs median 1, range from 1 to 2, respectively; P > 0.05). We found no relationship between the severity of the symptoms and the presence or severity of esophagogastric dysmotility. At midterm follow-up in patients with long-gap atresia that underwent primary repair, this study showed scintigraphic evidence of silent and serious esophagogastric dysmotility in symptom-free or minimally symptomatic children. It may therefore be unreliable to use symptoms in assessing the severity of esophagogastric dysmotility, since both groups showed similar clinical findings but different scintigraphic findings.

Topics: Anastomosis, Surgical; Child, Preschool; Esophageal Atresia; Esophageal Motility Disorders; Female; Follow-Up Studies; Humans; Infant; Male; Outcome Assessment, Health Care; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Sulfur Colloid

Gastro-oesophageal reflux (GOR) is a major cause of morbidity in children who undergo surgical repair for oesophageal atresia with tracheo-oesophageal fistula (OA/TOF). We performed a retrospective analysis to determine the incidence of GOR on radionuclide scintigraphy in symptomatic and asymptomatic OA/TOF patients in the first post-operative year. A total of 124 patients (74 males, 50 females), with a mean age of 3.5 months (range, 20 days to 12 months), were studied. Of these 124 patients, 67 were symptomatic and 57 were asymptomatic. On radionuclide scintigraphy, 73 patients (48 symptomatic and 25 asymptomatic) had reflux. Of the 48 symptomatic patients with scintigraphic studies positive for reflux, 79.2% (38) had proximal reflux and 20.8% (10) had distal reflux, whereas, of the 57 asymptomatic patients, 48% (12) had proximal reflux and 52% (13) had distal reflux. There was a significantly higher incidence of GOR in symptomatic children than in asymptomatic children (P<0.01). In particular, there was a significantly higher incidence of proximal GOR in symptomatic children than in asymptomatic children (P<0.001). In conclusion, the severity and incidence of GOR were significantly higher in symptomatic than asymptomatic OA/TOF patients in their first post-operative year. Scintigraphic evidence of proximal reflux correlates with the presence of symptomatic GOR.

Topics: Dilatation; Esophageal Atresia; Follow-Up Studies; Gastroesophageal Reflux; Humans; Incidence; Infant; Infant, Newborn; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula