bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOZ047.07: Parental feeding concerns of infants and children with esophageal atresia
Authors: Menzies Jessica , Hughes Jennifer 
Published: June 2019

Abstract

Background
Feeding problems have been described in children with esophageal atresia (EA). This can cause high levels of parental/caregiver concern.

Aims
The primary aim of this study was to determine specific feeding concerns of parents/caregivers of infants and young children with EA, including introducing solids and grading up to family foods.

Methods
A questionnaire was developed for parents/caregivers of infants/children with EA, aged 12 months to 6 years. Questionnaires were completed by 20 parents of infants/children attending a multidisciplinary EA clinic between June 2016 and June 2017. All children had type C EA. Demographics, feeding history, and parental concerns around feeding were assessed. The Montreal Children's Hospital Feeding Scale was also completed by parents.

Results
Eleven (55%) parents agree/strongly agree that they were concerned about their child's feeding prior to the introduction of solids and about moving from a smooth puree to more textured solids. The most common concerns were choking and food impaction for both time points. Twelve (60%) parents agree/strongly agree that the majority of mealtimes in their child's first 1–2 years of life were stressful. Thirteen (65%) parents reported avoiding particular foods due to their child's EA. The majority of children (n = 17) had no feeding difficulty according to an objective scale, with the rest minor.

Conclusions
This study highlights that parental concern around feeding still exists in infants and children without a severe feeding difficulty and needs to be addressed. Multidisciplinary involvement including a dietitian and speech pathologist from an early age is important for infants and children with EA. Further education provided to parents/caregivers may assist with reduced stress around feeding and create more positive mealtime behaviours.
DOZ047.110: Recurrent tracheoesophageal fistula tracheoscopic chemocauterization with trichloroacetic acid
Authors: Lara D P R , Riveros L V M , Pineda L R S , Padilla P O , Cañón I C , Luengas P , Garces A F , Machado C V 
Published: June 2019

Abstract

Objective
The aim of this study was to report the experience of two centers in the treatment of recurrent tracheoesophageal fistula (RTEF), by tracheoscopic chemocauterization with trichloroacetic acid (TCA). A surgical approach to RTEF has high morbidity and mortality. Some endoscopic techniques have been developed but nevertheless, optimal treatment is still not determined because of the low number of patients, short term of follow-up, and different techniques.

Materials and Methods
From January 2016 to March 2019, 12 patients with RTEF were selected for endoscopic management in two centers. Eleven had RTEF after primary repair of esophageal atresia/TEF and one had a second fistula with misdiagnosis, all of them by a thoracotomy approach. In all cases the diagnosis was confirmed by clinical evaluation, esophagram, and bronchoscopy. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope telemonitoring was used to localize and refresh the fistula with a small endoscopy brush of 2–3 mm. Cotton soaked with 50% TCA was applied on the fistula for 30 seconds. The procedure had to be repeated two times.

Results
Fistulae were closed in 10 patients. The closure was confirmed by esophagram or bronchoscopy after 2 months of the procedure. It remains completely obliterated and the patients are asymptomatic. There were only two patients with progressive decrease in the diameter of the fistula; one patient died for some other medical reason and another patient is being treated. The mean number of procedures in each patient was 1.3, and the follow-up was 12 months on average (2–36). Two patients had bronchospasms as postoperative complication.

Conclusion
The tracheoscopic chemocauterization of RTEF with the use of 50% TCA is a minimally invasive, safe, and effective technique. It has fewer complications and avoids the morbidity of open surgery.
DOZ047.115: Quality and readability of esophageal atresia information on the Internet
Authors: O’Connor B R , Doherty E , Friedmacher F , Vernon L , Paran T S 
Published: June 2019

Abstract

Introduction
Increasingly in pediatric surgical practice, patients, their parents, and surgeons alike use the Internet as an easily and quickly accessible source of information about conditions and their treatment. The quality and reliability of this information may often be unregulated. We aim to objectively assess the online information available relating to esophageal atresia and its management.

Methods
We performed searches for ‘oesophageal atresia’ and ‘esophageal atresia’ using the Google, Yahoo, and Bing engines to encompass both European and American spellings. We assessed the first 20 results of each search and excluded duplicates or unrelated pages. The DISCERN score and the Health on the Net Foundation Code (HONcode) toolbar were utilized to assess the quality of information on each website. We evaluated readability with the Flesch reading ease (FRE) and the Flesch–Kincaid grade (FKG).

Results
Of the original 120 hits, 61 were excluded (51 duplicates, 10 unrelated). Out of 59 individual sites reviewed, only 13 sites were HONcode approved. The mean overall DISCERN score was 52.55 (range: 22–78). The mean DISCERN score for the search term ‘oesphageal atresia’ was 57 (range: 22–78) in comparison to 59.03 for ‘esophageal atresia’ (range: 27–78). Google search had the lowest overall mean DISCERN score at 54.83 (range: 35–78), followed by Yahoo at 58.03 (range: 22–78), and Bing with the highest overall mean score of 61.2 (range: 27–78). The majority of websites were graded excellent (≥63) or good (51–62), 43% and 27%, respectively; 20% were scored as fair (39–50), with 10% being either poor (27–38) or very poor (≤26). In terms of readability, the overall Flesch Reading Ease score was 33.02, and the overall Flesch–Kincaid grade level was 10.3.

Conclusions
The quality of freely available online information relating to esophageal atresia is generally good but may not be accessible to everyone due to being relatively difficult to read. We should direct parents towards comprehensive, high-quality, and easily readable information sources should they wish to supplement their knowledge about esophageal atresia and its management.
DOZ047.13: Prophylactic endoscopic esophageal vacuum (EVAC) therapy of high-risk esophageal anastomoses in pediatric surgical patients
Authors: Yasuda J L , Svetanoff W J , Staffa S J , Ngo P D , Clark S J , Smithers C J , Manfredi M A 
Published: June 2019

Abstract

Summary
Esophageal anastomotic leak (EAL) is a potentially severe complication of surgical procedures of the esophagus. Vacuum-assisted closure (VAC) therapy is increasingly used in the treatment of EAL, with observational studies suggesting it is a highly effective method for esophageal defect closure.1–3 It was hypothesized that prophylactic esophageal VAC (EVAC) placement at the time of new anastomosis creation may improve blood flow and healing, potentially leading to fewer EALs.

Methods
Between July 2015 and November 2018, patients who underwent surgery that resulted in a new esophageal anastomosis and were deemed to be high risk for anastomotic complications had a prophylactic EVAC placed at the time of surgery. Retrospective review of similar surgical procedures without prophylactic EVAC placement from January 2014 to November 2018 was performed for comparison.

Results
Thirteen pediatric patients had prophylactic EVAC placement at the time of esophageal repair. Procedures prompting EVAC placement included primary repair of long-gap esophageal atresia (LGEA) by the Foker technique (N = 7), stricture resection after repaired LGEA (N = 3) or type C esophageal atresia (N = 1), and stricture resection after delayed identification of a retained esophageal foreign body (N = 2). Three of 13 patients who had prophylactic EVAC placement (23.1%) experienced EAL in the post-operative period. Two patients were found to have technical failure of their EVAC leading to absence of suction, and one patient experienced delayed EAL 12 days after removal of the EVAC. In comparison, post-surgical EAL occurred in 13 of 58 patients who had the Foker procedure for LGEA and in 8 of 31 patients who had esophageal stricture resection without prophylactic EVAC placement. The rates of EAL in the prophylactic EVAC group were not significantly different from rates of EAL in either the post-surgical Foker (23.1% vs 22.4%, P = 0.999), post-stricture resection (23.1% vs 25.8%, P = 0.999), or combined post-Foker and stricture resection (23.1% vs 23.6%, P = 0.999) groups by Fisher's exact test.

Conclusions
Prophylactic EVAC placement does not carry increased risk of EAL compared to standard post-surgical care; however, further device refinement is needed to reduce technical failure.
DOZ047.14: Endoscopic incisional therapy and other novel strategies for treatment of congenital esophageal stenosis
Authors: Yasuda J L , Staffa S J , Clark S J , Ngo P D , Jennings R W , Manfredi M A 
Published: June 2019

Abstract

Summary
Management of congenital esophageal stenosis (CES) often involves dilation with reversion to myotomy or stricture resection in refractory cases.1,2 However, surgery often fails to produce durable response, with anastomotic strictures requiring ongoing dilation and stenotic symptoms plaguing more than half of the patients in published series.3

Methods
In this study, the medical records of all patients with CES treated by our tertiary care center who had at least one endoscopy between July 2007 and October 2018 were retrospectively reviewed. Success was defined as full when the diet included all age-appropriate textures with dysphagia once per month or less, or partial when the diet included most textures with dysphagia at most 1–2 times per week.

Results
Thirty patients with CES had at least one endoscopic intervention. All patients had balloon dilation(s) and at least one other therapy such as endoscopic incisional therapy (EIT), steroid injection, or stenting. Esophageal vacuum-assisted closure (EVAC) was used for treatment or prevention of esophageal leak. Of patients who had EIT at their CES (N = 18), 14 (77.8%) achieved full (N = 13) or partial (N = 1) success with endoscopic therapy alone; 3 (16.7%) required surgery to achieve full (N = 3) success; 1 nonsurgical patient does not yet eat by mouth due to oral aversion. Of patients who did not undergo EIT at their CES (N = 12), 5 (41.7%) achieved full success with endoscopic therapy alone; 7 (58.3%) required surgery (2 full success, 4 partial success, and 1 does not eat by mouth due to airway comorbidities). The rate of surgical intervention was significantly lower in the group that received EIT (Fisher's exact test, P = 0.045). Twenty-five endoscopies (8.9%) were associated with complications, including esophageal leak (N = 21) or stent migration (N = 4). Of endoscopies with a complication, 16 (64%) involved EIT. Odds of complications after therapeutic endoscopies involving EIT were significantly higher than those without EIT (odds ratio 6.15; 95% CI (2.44, 15.52); P < 0.001). The rates of esophageal leak significantly decreased over time as the use of EVAC increased (P = 0.003).

Conclusion
EIT shows promise as an alternative to surgery in CES; however, further study is needed. Complementary endoscopic techniques such as injection, stenting, and EIT broaden the toolbox of the treating physician and may allow for avoidance of surgery in CES.
DOZ047.19: Outcomes in the management of long-gap esophageal atresia: is the Foker technique superior?
Authors: Wiseman A , Krishnan J , Wanaguru D , Langusch C , Varjavandi V , Jiwane A , Dilley A , Adams S , Henry G , Currie B , Krishnan U 
Published: June 2019

Abstract

Background
Long-gap esophageal atresia (LGEA) has traditionally been managed by delayed anastamosis. However, over the last 10 years the Foker technique of esophageal growth elongation has been used. There is limited data evaluating outcomes using both techniques.

Aims
The aim of this study was to compare the outcomes in LGEA repair using the traditional delayed repair technique versus the Foker technique.

Methods
A retrospective chart review was done of LGEA patients at Sydney Children's Hospital between 1997 and 2016, comparing the Foker technique with the delayed repair technique.

Results
There were 9 children repaired using the Foker technique, and 10 by delayed repair. There were 7 patients with Type A, 1 with Type B, and 1 with Type C in the Foker group and in the delayed repair cohort, 5 were Type A, 2 Type B, 2 Type C, and 1 Type D esophageal atresia/tracheoesophageal fistula. There were 4 males in the Foker group and 5 in the non-Foker group. Median time to join was 59 days (15–117 days) for Foker repair and 173 days (16–433 days) for delayed repair. There was no significant difference in the incidence of post-operative leak, incidence of strictures needing dilation, presence of reflux symptoms, presence of reflux esophagitis on endoscopy, proton pump inhibitor use, need for fundoplication, incidence of cyanotic spells, occurrence of recurrent fistula, and symptoms of dysphagia when comparing both groups. Data on time to oral feeds and incidence of malnutrition was incomplete. Details are shown in Table 1.

Conclusions
Although the time to anastamosis was shorter in the Foker group and the incidence of post-operative leak, strictures needing dilation, need for fundoplication, and dysphagia were lower in the Foker group, the difference was not significant probably secondary to the small sample size. These results require validation in larger cohorts.
DOZ047.20: Growth, feeding difficulties, and developmental scores in children born with esophageal atresia: a single-center study
Authors: Grech A , Kwan M , Hatton L , Robinson P , Karpelowsky J , Collin M , Tzannes G , North H , Fitzgerald D A 
Published: June 2019

Abstract

Background
Children with repaired tracheoesophageal fistula/oesophageal atresia (TOF/OA) often have ongoing feeding difficulties and poor growth related to esophageal dysmotility, strictures, gastroesophageal reflux, aspiration, and respiratory infections. The impact of neurocognitive development on feeding in this cohort is less well studied.

Objective
The objective of this study was to investigate the growth, parent-reported feeding difficulties, and developmental scores of children with TOF/OA at The Children's Hospital at Westmead in Sydney, Australia.

Methods
The validated Montreal Children's Hospital Feeding Scale (MCH-FS) was completed by parents of patients aged 6 months to 6 years at a multidisciplinary aerodigestive clinic between February 2016 and October 2018. Growth, developmental outcomes (using the Bayley Scales of Infant and Toddler Development [BAYLEY-III]), demographic information, OA subtype, and associated comorbidities were reviewed.

Results
Forty-three caregivers completed the MCH-FS at least once, with questionnaires returned up to five times, totaling 101 reviews. The mean age was 4 years (± 1.9) and 53% were female. Thirty percent of patients were born prematurely and 30% had VACTERL association. Mean [± SD] growth z-scores were below WHO/CDC means for weight (−0.86 ± 1.37), length/height (−0.70 ± 1.2), and weight-for-length/BMI (−0.35 ± 1.15). BAYLEY-III scores were available for 27 children at 13 (± 1) months. Mean scores for four domains were within ‘average’ range (8–12): cognition (11 ± 2), receptive language (8 ± 3), expressive language (8 ± 2), and fine motor skills (9 ± 2). The mean gross motor score was below average (7 ± 3). Parent-reported feeding difficulties were moderate. When first completed, cumulative MCH-FS scores indicated 44% of patients had severe feeding difficulties, 40% moderate, and 14% mild. Sixty percent of patients required referral to a speech pathologist. However, most parents did not feel that these feeding difficulties influenced the relationship with their child or their family (88% and 84%, respectively).

Conclusions
The majority of patients in the cohort experienced significant feeding difficulties and some below average developmental scores, underscoring the need for multidiscplinary support for children born with TOF/OA. Further work in correlating growth, developmental, and feeding outcomes within subjects will assist in identifying early risk factors that may highlight infants most predisposed to these challenges, and who may benefit from early intervention.
DOZ047.21: Esophageal atresia and long-term quality of life in Italian population: a pilot study
Authors: Parracciani M , Tona C , Gamba P , Dall’Oglio L , Conforti A , Cheli S 
Published: June 2019

Abstract

Introduction
In Italy, long-term outcomes of esophageal atresia (EA) are poorly understood. The Italian Association ‘Family with Esophageal Atresia’ (F.AT.E.) and Tages Onlus, and some Italian pediatric centers of reference for AE, collaborated to define the first work about long-term outcomes and quality of life (QoL) in a cohort of Italian adults and young adults born with AE. As a rare disease, given the specificity of the reference population and the absence of similar research, this study was in any case designed to be a pilot study.

Methods
To date, 65 adults born with EA have participated in completing the questionnaire. Two survey formats were created: (i) a standard paper questionnaire and (ii) an online platform. The questionnaire included the following tools: (i) socio-personal data; (ii) QoL questionnaire (SF-36); (iii) a sub-battery of short questionnaires to investigate psychological adaptation to chronic diseases (HADS, IES-R, Brief-COPE); (iv) a questionnaire linked to the specific perception of social support (MOS-SSQ); and (v) four open questions developed to investigate the subjective experience of QoL and long-term morbidity. The use of quantitative and qualitative data (Mixed Methods) will allow us to deeply investigate the experience and perceptions related to the QoL.

Results
Our results indicated that AE type C is the most frequent, and the renal ones are the most common malformations associated with AE. According to the dysphagia score, more than half are suffering states of dysphagia. A significant negative statistical association emerges between the presence of dysphagia and perception of social support (MOSS-SSS). Gastroesophageal reflux symptoms are reported by more than half, in association with antireflux medications. At last, it emerges that the main psychological factors accused are sleep disorders and obsessive-compulsiveness symptoms.

Conclusions
Despite this study confirming that the frequency of respiratory, gastrointestinal, and musculoskeletal symptoms affects the QoL, it appears generally good. The information provided by this study could be an incentive to implement and improve long-term follow-up programs and to involve more specialist adult doctors in the care of these patients.
DOZ047.35: Early parental adjustment in esophageal atresia and other rare abdominothoracic malformations
Authors: Ribeiro M-H , Hanafi M , Michaud L , Blanc S , Lapillonne A , Mur S , Gelas T , Kermorvant E , Gottrand F , Guerrien A , Coulon N 
Published: June 2019

Abstract
Parents of a child with a congenital malformation including esophageal atresia (OA), congenital diaphragmatic hernia (CDH), or intestinal atresia (IA) have to face various potentially stressful situations and exercise their role in a highly medicalized context. Yet no study has so far sought to identify the factors that facilitate or make difficult their adjustment of the first months.
This study aimed to propose a grounded theory to account for the dynamics of parental adjustment for the period from the announcement of the diagnosis to the age of one year of the child with a rare abdominothoracic malformation requiring neonatal surgery. Participants were recruited to form a reasoned sample of 30 parents of children aged from 12 to 36 months with an OA, a CDH, or an IA. To date, 22 parents (17 mothers and 5 fathers) have been included. Semistructured individual interviews were conducted in which four main themes were discussed: the medical and hospital care of the child, the daily life with the child at home, the consequences of the illness on family life, and personal experience.
Preliminary results show that the child's condition impact parental adjustment and family functioning. Parents reported high level of distress and fatigue during the first year of their child. The highly medicalized context makes it more difficult for parents to practice their parental role and bring them to expense energy to implement normalization strategies in their parental practices.
Interestingly, the relationship with doctors and medical staff has been widely discussed by parents. Most of them felt a lack of information about their child's condition, or felt that the information was not authentic. Some of them felt that doctors were trying to protect them by omitting certain events that they ended up learning by the medical staff. All parents pointed the availability, the quality of the educational relationship, the emotional and informational support from the medical staff allowing them to feel more effective and to reduce their negative feelings.
Results of our study will be used to design appropriate psychoeducational interventions in order to improve support for families.
DOZ047.37: 5-year follow-up after 17 laparoscopic transhiatal esophagectomy and gastric pull-up (TEGPUL)
Authors: Perera A P , Pasten A 
Published: June 2019

Abstract

Background
Survival in patients with EA.

Materials and Methods
Between 2011 and 2015, we performed 17 transhiatal esophagectomy and gastric pull-up (TEGPUL) in 8 girls and 9 boys, with a mean age 34 months (range: 8–99 months). All born with EA 65% (11) were acquired long-gap (EA type III, those where a primary anastomosis was initially achieved and then lost because of complications and redo surgeries) and 35% (6) congenital long-gap (EA types I and II). Immediate, mediate, and late complications were recorded. They were contacted by email, Facebook, instagram, and WhatsApp. WHO charts were used for nutritional diagnosis.

Results
Mean operating time 5.5 hours (3.5–8 hours), mean days of mechanical ventilation 4.5 (2–8 days), mean days of hospitalization 18 (9–40 days), mean time of oral feeding 12.5 days (3–30 days). We contacted 92% of the living patients. Immediate complications (first 14 postoperative days): 3 (18%) reoperative surgery (2 acute gastric obstruction and 1 incidental colon perforation); 3 (18%) patients had perioperative cardiac arrest (2 in-OR and 1 out-OR) all left but one, with neurological sequelae, died on the 12th postoperative day; 8 patients (47%) had a leak of the esophagogastric anastomosis, all health spontaneously in an average of 15 days and high blood pressure in 10 (59%) patients, unknown etiology. Mediate complications (from 15 postoperative days to 3 months): gastric emptying delay 3 (18%), GER 5 (29%), and recurrent lower respiratory infections 9 (53%). Late complications (from 3 months to 5 years): malnutrition 2 (18%), risk of malnutrition 3 (27%), diaphragmatic hernia 1 (9%), upper gastrointestinal bleeding 1 (9%). Postoperative parents satisfaction 100%.

Conclusion
TEGPUL is a safe and reproducible esophageal replacement technique in patients with long-gap EA, but have a long learning curve. However, more long-term and larger follow-up studies are needed, for which we recommend grouping these patients in a national reference center.