APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso

Risk factors for the development of post-operative stricture include anastomotic tension, long gap atresia, leak, gastroesophageal reflux, and more recently, trans anastomotic tubes have been implicated.

Use of transanastomotic tubes has increased since the 1980s, the rationale being a shorter time to feeds and a shorter duration of postoperative TPN.

Due to recent studies implicating transanastomotic feeding tubes as an independent risk factor for strictures, Montreal Children's Hospital initiated a moratorium on their use until evaluating their own outcomes.

The study population included all type C and type D EA/TEF patients at three university-affiliated hospitals in Quebec over a 25-year period between 1993 and 2018.

Inclusion criteria required primary repair within 6 months of birth and at least 1 year follow-up.

Stricture was defined as symptoms with imaging confirmation by either upper GI or endoscopy at one year.

Of 371 EA/TEF patients born during the study period, 344 were type C or D, and 244 were included in the final analysis.

About 30% of patients had strictures, and transanastomotic tubes were used in 61% of patients.

On univariate analysis, transanastomotic tubes were significantly associated with strictures.

On multivariate analysis adjusting for gestational age, leak, long gap, anastomotic tension, and daily acid suppression, transanastomotic tubes conferred almost 3 times higher odds of developing a stricture compared to those without.

Days on postoperative TPN were the same between groups with and without transanastomotic tubes.

All patients in the study cohort were on TPN.

Days to first enteral feeding were shorter in the transanastomotic feeding tube group than those without.

Transanastomotic feeding tubes are associated with an increased rate of postoperative strictures and decreased time to enteral feeding, but do not confer a major benefit in the number of days on postoperative TPN.

In the study data, only about 30 cases out of 244 patients were done thoracoscopically, which is insufficient to definitively determine whether MIS techniques impact stricture rates.

One standard type of tube was used as the transanastomotic feeding tube in the study.

Data on replacement tubes when children fail oral feeding is difficult to analyze retrospectively and needs to be captured in future prospective studies.

Transanastomotic tubes potentially increase inflammation and acid exposure to the anastomosis, which may increase stricture rates overall.