Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 5, September-October, p. 917–922

doi: 10.17219/acem/61844

Publication type: original article

Language: English

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Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula

Barbara M. Iwańczak1,A,B,C,D,E,F, Agnieszka Kosmowska-Miśków1,B,C,D,F, Anna Kofla-Dłubacz1,B,C,D,F, Mateusz Palczewski2,B,C,D,F, Michał Grabiński1,B,C, Katarzyna Pawłowska1,B,C, Krzysztof Matusiewicz1,B,C,E,F, Dariusz Patkowski2,A,C,E,F

1 Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Poland

2 Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland

Abstract

Background. Motility disturbances of the esophagus and gastroesophageal reflux disease (GERD) are observed frequently in children after repair of congenital esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Recently, in many pediatric surgical centers, thoracoscopic repair was introduced, which theoretically would change the postoperative course.
Objectives. The goal of the study was to assess physical development, disease symptoms, and GERD symptom frequency in children who underwent thoracoscopic surgery of congenital EA/TEF.
Material and Methods. The study comprised 22 children (14 boys and 8 girls), aged 16 to 79 months (average age 47.3 months) after surgery of EA/TEF. Clinical symptoms and physical development were analyzed. In 19 children, multichannel intraluminal esophageal impedance connected with pH-metry (MII/pH) was performed. In 11 patients, esophagogastroduodenoscopy with a histological study of mucosa samples was done.
Results. The most frequent symptoms were dysphagia, belching, cough and recurrent bronchitis. In 31.5% of the children, body mass deficiency was observed and in 28.6%, low body mass and short stature. Prematurity was present in half of the patients. Depending on the result of the MII/pH study, the children were divided into two groups: 10 children with GERD and 9 children without diagnosis of gastroesophageal reflux. In the 10 with GERD, acid reflux was diagnosed in 9 and non-acid reflux was diagnosed in one. MII/pH demonstrated statistically significant differences in the number of reflux episodes, reflux index, bolus exposure index, mean time of esophageal exposure and acid exposure and mean acid clearance time in children with GERD in comparison to children without this disease. In 36.4% of children who underwent endoscopy, esophagitis was diagnosed, esophageal stricture in 18% and gastric metaplasia in 9.1%.
Conclusion. In children who underwent corrective thoracoscopic surgery of EA/TEF, GERD caused by motility disorders of the esophagus was frequently observed. These children require constant monitoring and early treatment of the complication.

Key words

esophageal atresia, tracheoesophageal fistula, thoracoscopy, gastroesophageal reflux disease, MII/pH

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