Endoscopic findings in children born with oesophageal atresia in an academic unit in South Africa

Authors

Keywords:

oesophageal atresia, endoscopy, morbidity, long-term outcomes

Abstract

Background: Oesophageal atresia (OA) is one of the most common congenital gastrointestinal (GI) abnormalities. Due to advances in multidisciplinary care, early prognosis has improved with emphasis shifting to the long-term impact of this disease. Literature suggests a higher incidence of Barrett’s and eosinophilic oesophagitis in these children, with an increased risk of oesophageal carcinoma.  Guidelines for adults born with OA include routine endoscopy and lifelong screening of the upper gastrointestinal tract (GIT). Despite this, uncertainty remains regarding the necessity and frequency of endoscopic surveillance for children born with OA. We describe our endoscopic findings in children born with OA.

Method: A prospective analytic cohort study was undertaken, which included all children born with OA, that were followed-up in our unit between 2020 and 2022. History regarding feeding and GI symptoms were documented after which an endoscopy was performed.

Results: During the study period, 37 endoscopies were performed in patients born with OA at a median age of 25 months. The most common clinical appearance on endoscopy was anastomotic strictures followed by oesophagitis. Twelve patients had biopsies taken, with abnormal histology in all but one patient. The most common histological finding was oesophagitis with lymphocytes and chronic gastritis. Two patients had Helicobacter Pylori infection, and one had findings suggestive of eosinophilic oesophagitis.

Conclusion: All patients with a clinical indication for an endoscopy had abnormal clinical or histological findings, thus concurring with the literature in highlighting the need for regular endoscopy. We recommend regular clinical follow-up and endoscopic surveillance if clinically indicated for children born with OA.

Author Biographies

C de Vos, Stellenbosch University

Division of Paediatric Surgery, Department of Surgical Sciences, Stellenbosch University and Department of Paediatric and Child Health, Stellenbosch University, South Africa

N Fourie, Stellenbosch University

Division of Paediatric Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa

B Banieghbal, Stellenbosch University

Division of Paediatric Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa

PT Schubert, Stellenbosch University

Division of Anatomical Pathology, Department of Pathology, Stellenbosch University, South Africa

D Sidler, Stellenbosch University

Centre for Medical Ethics and Law, Stellenbosch University, South Africa. Caring for Children: Paediatric Surgery in the Department of Paediatrics and Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa

P Goussard, Stellenbosch University

Department of Paediatric and Child Health, Stellenbosch University, South Africa

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Published

2024-03-28

Issue

Section

Paediatric Surgery