bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOZ047.24: Predictors of early and late mortality in esophageal atresia patients
Authors: Tanny S P T , Fearon E , Hawley A , Brooks J , Comella A , Hutson J M , Teague W J , Pellicano A , King S K 
Published: June 2019

Abstract

Background
Esophageal atresia (EA) is associated with mortality, despite significant advances in neonatal care. Predictors of early mortality (EM) are well described in the literature. However, little is known about late mortality (LM). This study aimed to describe EM and LM rates and their associations in EA patients.

Methods
Patients with EA, managed at The Royal Children's Hospital, Melbourne (1980–2017), who subsequently died, were identified from the Nate Myers Esophageal Atresia database. Data collected included patient demographics, VACTERL associations, mortality risk factors, and preoperative, operative, and postoperative findings. Early mortality was defined as death during initial admission.

Results
A total of 90/628 (14.3%) patients died during the study period—EM occurred in 68/90 (75.6%), whilst LM occurred in 22/90 (24.4%). Causes of EM were most often palliation for respiratory anomalies (17/68, 25.0%), followed by associated syndromes (11/68. 16.2%) and neurological anomalies (10/68, 14.7%). The most commonly associated syndrome leading to palliation was trisomy 18 (7/68, 10.3%). Causes of LM were most often respiratory compromise (6/22, 27.3%), sudden unexplained deaths (6/22, 27.3%), and Fanconi's anemia (2/22, 9.1%). Of patients discharged from hospital, 22/560 (3.9%) subsequently died. There was no difference in VACTERL association between EM (32/63, 50.8%) and LM (11/20, 55%) (P = 0.80), and no difference in the incidence of twins between EM (8/58, 13.8%) and LM (2/18, 11.1%) (P = 1).

Conclusion
We identified predictors of early and late mortality in esophageal atresia in a large cohort. Parents of children with esophageal atresia must be counseled appropriately as to the likelihood of death following discharge from hospital.
DOZ047.29: Pleural flap for partial esophageal substitution in case of difficult anastomosis
Authors: De Napoli Cocci S , Faraj S , Guinot A , Joseph S , Caldari D , Leclair M-D 
Published: June 2019

Esophageal reconstruction in long-gap atresia remains challenging for the surgeon.
Complications of surgery, regardless of choices and methods proposed, are frequents, sometimes serious, and can significantly delay baby's feeding, with increased disruption of orality.
The ideal is a reconstruction with only esophageal tissue available.
There is renewed interest for technical of elongation described initially by Foker, especially modified by Van Der Zee.1
But, elongation is not always so simple that provided.
We report an observation of esophageal atresia (type 1 Ladd), treated by rapid elongation. On the sixth day of procedure, right pleurisy reveals a rip at the apex of inferior esophagus.
Anastomosis was possible on the posterior plane, but impossible on the anterior plane. The anterior plane has been reconstituted with a flap of parietal pleura. The operative course was simple without any fistula. Oral feeding started at fifteenth day postanastomosis was quickly complete. Gastrostomy left by security has not been used.
Three endoscopic dilations have been necessary at six weeks, two and five months after anastomosis.
At the age of eleven months, the orality was perfect, and diet was diversified with pieces.
Use a pleural flap to bury or isolate sutures is well known technic.2 But use only pleura to replace the esophageal wall is not described.
Partial reconstruction of a hemiesophageal wall with only pleura is possible, despite difficult conditions. It is a trick easily achievable in case of difficulty, with a good result that is maintained over time.
DOZ047.31: Screening and surveillance in adults after esophageal atresia repair: yield of follow-up endoscopies
Authors: Ten Kate C A , IJsselstijn H , Bruno M J , Wijnen R M H , Spaander M C W 
Published: June 2019

Abstract

Aim of the Study
Because of the high prevalence of Barrett's esophagus (BE) and esophageal carcinoma, it is internationally recommended to perform routine endoscopies in adult esophageal atresia (EA) patients. This study aimed to evaluate the yield of follow-up after the first screening endoscopy.

Methods
Prospective cohort study in a tertiary referral center since November 2011 was considered. All patients with EA ≥ 17 years old were invited to participate in the screenings and surveillance program. All patients underwent upper endoscopies with random biopsies of the distal esophagus at the level of the gastroesophageal junction and standard four-quadrant biopsies in case of BE. From the age of 25 years old chromoendoscopy with Lugol's staining was performed for detection of superficial squamous cell carcinoma. Depending on their age and the histologic results patients were recommended follow-up endoscopy every 3–5 years. Ethical approval had been obtained.

Results
In February 2019, 190 patients (58% male, 83% type C, median age at time of first endoscopy 25.5) (range: 16.8–68.6 years) participated in the screenings and surveillance program. Forty-six patients underwent at least one follow-up endoscopy after median 4.7 (range: 1.0–5.9) years. Most recent surveillance endoscopy revealed a normal esophagus in 62%, esophagitis in 10%, and columnar-lined esophagus in 26% of the patients. Histology revealed inflammatory changes within normal limits in 49%, esophagitis in 22%, gastric metaplasia in 18%, and intestinal metaplasia without dysplasia in 6%. In 8 patients (6 males, median age: 25.9 (range: 22.5–34.4)) columnar-lined mucosa was a new finding at the second endoscopy, after median 5.0 (range: 3.6–5.9) years. In two of them histology revealed intestinal metaplasia without dysplasia.

Conclusions
In line with previous studies, we found a 4-times increased prevalence (6.3%) of BE in adults with EA. Follow-up endoscopies detected two new cases of BE. Future studies are needed to identify patients at risk and personalize screening and surveillance regimes.
DOZ047.39: Respiratory morbidity at the age of one year in children with esophageal atresia: data from the French National Esophageal Atresia Register
Authors: Lejeune S , Rousseau V , Bonnard A , Michaud L , Gelas T , Boubnova J , Jacquier C , Irtan S , Breton A , Fouquet V , Guinot A , Lamireau T , Habonimana E , Schneider A , Elbaz F , Ranke A , Poli-Merol M L , Allal H , Petit T , Michel J-L , Buisson P , Sapin Z , Lardy H , Levard G , Lopez M , Schmitt F , Borderon C , Jaby O , Pelatan C , De Vries P , Pouzac-Arnould M , Grosos C , Breaud J , Tolg C , Auber F , Geiss S , Laplace C , Sfeir R , Gottrand F , Drumez E , Mourad S El , Thumerelle C 
Published: June 2019

Summary
Respiratory diseases are common in children with esophageal atresia (EA), leading to an increased morbidity and mortality in the first months of life.

Objective
Assess the prevalence of hospitalizations linked to a respiratory disease and of maintenance inhaled therapy at the age of 1 year in French children.

Methods
Population based-study using data from the French national EA register. We included all children born between 2010 and 2015 with data available at birth and at follow-up at one year of age.

Results
A total of 981 patients born with EA were included in the register, 75 of them (8%) being deceased at the age of 1 year. Data were missing for 60 patients, thus 846 children (86%) were retained for analysis. EAs were type III of Ladd classification in 89% and type I in 7%. Rate of prematurity was 37% while 51% presented associated malformations. At 1 year of age, 1297 hospitalizations were reported for 508 patients (60%), at least one hospitalization for a respiratory disease for 251 children (51%). Factors significantly associated with respiratory hospitalizations were longer median length of oxygen supplementation (P < 10−2) and noninvasive ventilation in the neonatal period (P = 0.02), gastrostomy tube (P < 10−2), esophageal anastomosis dilation (P < 10−2). At 1 year of age, 29% had an inhaled maintenance treatment, and 85% inhaled corticosteroids. Factors significantly associated with inhaled maintenance treatment were male gender (P = 0.04), advanced older median age at gastrostomy tube insertion (P < 10−3), enteral feeding at one year of age (P < 10−3).

Conclusion
This study shows a high rate of respiratory problems responsive of frequent hospitalizations and inhaled maintenance treatment in children born with EA in the first year of life.
DOZ047.41: Tracheomalacia after esophageal repair: a systematic review
Authors: Aanen I P , Elders B B L J , Pullens B , Wijnen R M H 
Published: June 2019

Abstract

This study was performed to obtain an overview of literature on diagnosing tracheomalacia (TM) in patients with esophageal atresia (EA). The aim of this study is to find answers in the literature on the following questions: (1) How often is a TM seen on preoperative scopy? (2) What is the predictive value of preoperative scopy findings on postoperative TM outcome? (3) How often is tracheomalacia seen in postoperative scopy in EA? (4) How often is tracheomalacia severe?

Methods
A systematic literature search to identify studies on pre-, per-, and postoperative endoscopy to identify TM in patients with EA was performed. TM was classified into the following categories: mild, moderate, and severe, based on percentage of collapse of the trachea seen on tracheobronchoscopy (TBS) and/or clinical symptoms. The following databases were searched: Embase, Medline Epub (Ovid), Cochrane Central, Web of Science, Google Scholar. The search strategy contained ‘oesophageal atresia’ and ‘tracheo-oesophageal fistula’ and ‘tracheomalacia’ and ‘pediatric.’

Main Results
A total of 43 articles were included. Of the studies who conducted initial TBS pre- or peroperative, 6 described TM incidences, ranging from 7% to 65%. One study reported a sensitivity of dynamic fiberoptic bronchoscopy at time of initial repair as a test for symptomatic TM of 86% and a specificity of 54%. The positive and negative predictive values were 71% and 75%, respectively. Thirty-three studies described postoperative TM incidences ranging from 0% to 89% overall. Of the patients who were identified with TM 8–53% were classified as severe, e.g., in need of surgical intervention or according to institute guidelines on collapse percentage at endoscopy.

Conclusions
Although most medical centers carry out airway endoscopy pre- or peroperative in EA-repair patients, reports on TM incidences at this time point are still poor. Postoperative TM occurs highly in symptomatic patients with a substantial number of airway interventions.
DOZ047.55: Midterm follow-up of long-gap esophageal atresia national cohort: study of feeding difficulties and morbidity
Authors: Thomas J , Gottrand F , Levard G , Lamireau T , Michaud L , Sfeir R , Michel J-L , Carcauzon V , Pouzac M , Branchereau S , Petit T , Sapin E , Piolat C , Allal H , Lemelle J-L , De Napoli Cocci S , Ricard J , Merol M L P , Elbaz F , Lardy H , Schneider A , Mure P-Y , Audry G , Auber F , Rousseau V , Bonnard A , Varlet F , Parmentier B 
Published: June 2019

Abstract

Introduction
Long-gap esophageal atresia (LGEA) leads to multifactorial morbidity. The aim of this study is to analyze midterm gastrointestinal and respiratory morbidities with special assessment of feeding difficulties. Secondary goals were to determine risk factors of malnutrition and the impact of surgical techniques on morbidity.

Methods
We conducted a prospective observational national study. Using French national database, we reviewed medical charts of every patient treated for LGEA between 2008 and 2010 in France. Phone contact was proposed to assess orality disorders using Functional Oral Intake Scale (FOIS). Patients with complete data were included. We compared conservative management with esophageal replacement.

Results
We included 31 cases with a median age of follow-up of 9 years [7–10]. Median z-score for weight was −0.97 [−3.52–2.50], <to −2DS in eight patients (26%). Eleven patients (35%) had a medical treatment for gastroesophageal reflux (GER), 10 children (35%) had required at least one dilatation for stricture (median number of 2 [0–10]) and 17 patients (55%) complained of food impaction. Enteral feeding was required in three patients (10%). Orality disorders were present in 16 cases (52%). Ten children (30%) required a daily treatment for asthma and 3 (10%) had recurrent pulmonary infections. Low birth weight, preterm birth, congenital malformations, GER, dysphagia, abnormal FOIS and asthma were not associated with malnutrition. Conservative strategy was significantly associated with orality disorders (P = 0.04).

Conclusion
Midterm morbidity in LGEA concerns 80% of our population. Gastrointestinal morbidity includes mainly dysphagia, GER, and orality disorders. This study suggests that conservative management provides more orality disorders. Other studies are mandatory to confirm it.
DOZ047.56: Esophageal stent placement for the treatment of severe stricture after the operation for esophageal atresia—preliminary report
Authors: Jasinskaa A , Wolskia M , Banaszkiewiczb A , Kaminskia A 
Published: June 2019

Abstract

Introduction
Anastomotic stricture is the most common complication after the treatment of esophageal atresia. It occurs in 20%–80% of operated patients. The stricture can be usually effectively managed by repeated bougie or balloon dilations. Stent placement therapy is reserved for severe strictures.

Material and Methods
Between 2006 and 2018, 73 patients with esophageal atresia were admitted to the clinic. The esophagus was anastomosed in 63 of those patients. Clinical history of three patients with severe stricture treated with stent placement was analyzed retrospectively.

Results
Two patients were treated for esophageal atresia with lower tracheoesophageal fistula and one without the fistula (type ‘A’). In two patients, the undertension primary anastomosis was possible. The third patient underwent esophageal reconstruction with the large curvature of the stomach after upper esophagus elongation (Collis procedure). Anastomotic leakage and severe anastomotic stricture occurred in all three patients. Severe stricture was the indication for stent placement in two cases and a perforation during the dilation procedure in one. All stents were removed after the period of one week. The removal was accelerated by the aggravation of tracheomalacia symptoms in one case and by the onset of pulmonary tract infection due to gastroesophageal reflux in another. The third stent migrated to the stomach and had to be removed during endoscopy. One patient, qualified for stent therapy due to the perforation, did not require any other dilations after stent removal. In one patient with severe stricture, the stent therapy accelerated the healing—the narrowing never got tighter than the stent diameter and he required only three more dilations. In the third patient, no positive impact of the stent therapy was observed.

Conclusions
Stent placement for severe esophageal stricture after anastomosis was the definite therapy in one patient and substantially reduced the number of required dilations in one. Complications of the stent placement appeared in two out of three patients.
DOZ047.71: Long-gap vs. non-long-gap esophageal atresia: a prospective two-year follow-up study
Authors: Valfre L , Conforti A , Scuglia M , Aite L , Bevilacqua F , Iacobelli B D , Braguglia A , Bagolan P 
Published: June 2019

Abstract

Aim of the Study
Long-gap esophageal atresia (LGEA) represents the most challenging spectrum of esophageal atresia (EA). This condition is poorly defined, particularly regarding long-term sequelae. The aim of this study was to evaluate mid-term outcomes of patients with LGEA.

Methods
A longitudinal prospective study was performed of all EA patients treated at our institution from January 2008 to December 2016. Patients were followed up in a dedicated multidisciplinary outpatient clinic. LGEA was defined as a gap wider than 3 vertebral bodies at preoperative gap measurement. Data were collected with specific attention to auxological outcomes, esophageal dilations, antireflux procedures, redo-esophageal surgery, readmission, and dysphagic problems. Chi-squared test and Mann–Whitney test were used as appropriate; P < 0.05 was considered significant.

Results
During the study period, 183 EA patients were treated, 52 with LGEA. Of those, 151 reached a minimum of 1-year follow-up and were enrolled into this study. Long-gap vs non-long-gap: weight 1st year, gr; 6800 vs 8800 P < 0.0001; weight 2nd year 9500 gr vs 11000 p < 0.0001. BMI 1st year, median 14,75 vs 15,64 p 0.04; BMI 2nd year, median 15,18 vs 15 p 0.9; N° dilations 1st year, median 3 vs 1 P < 0.0001, N° dilations 2nd year, median 1 vs 0 P < 0.0001; Nissen 1st year, n (%) 9 vs 3 p 0.0019; Nissen 2nd year, n (%) 12 vs 4 p 0.0002. Redo-esophageal surgery 1st year, n (%) 7 vs 7 p 0.14. Redo-esophageal surgery 2nd year, n (%) 8 vs 0 < 0.0001. Readmission 1st year, median 4 vs 2 P < 0.0001; readmission 2nd year, median 3 vs 0 P < 0.0001. Oral aversion 1st year, n (%) 27 vs 10 P < 0.0001; oral aversion 2nd year, n (%) 17 vs 6 P < 0.0001. Dysphagia 1st year, n (%) 25 vs 18 P < 0.0001; dysphagia 2nd year, n (%) 14 vs 19 p 0.13.

Conclusions
LGEA patients underwent a more challenging course at follow-up, experiencing late auxological, more esophageal and GERD-related problems, and increased feeding and swallowing disorders in comparison with non-LGEA patients. A longer follow-up study is warranted to describe late and/or persistent problems.
DOZ047.72: Three-dimensional printing for preoperative planning of open laryngotracheal surgery
Authors: Fishman G , Wasserzug O , Berman P , Golden E , DeRow A 
Published: June 2019

Abstract

Background
Three-dimensional (3D) printing is being employed in a variety of surgical specialties to improve patient care. These models enable preoperative in vitro planning, advanced resident training, and better patient education. 3D models of the tracheobronchial tree that can simulate bronchoscopy and 3D printed cricoid cartilage models for balloon dilation training have been reported. A 3D model for preoperative planning of open laryngotracheal surgery has not been reported.

Objectives
The objective of this study was to report preliminary results with the employment of 3D printing technology for preoperative planning of laryngotracheoplasty (LTP) and cricotracheal resection (CTR).

Materials and Methods
Actual-size 3D models of the upper airway, from the level of the base of tongue to the level of the carina, have been created by the surgical 3D printing lab in the medical center. The models were based on computed tomography of two patients who were scheduled for LTP and CTR. The models were composed of several elements: the framework of the larynx and the trachea, the air column, the cannula, and the peri-stomal region.

Results
Two models were created, a model of a patient with grade III subglottic stenosis who subsequently underwent LTP and a model of a patient with grade IV subglottic stenosis who subsequently underwent CTR and end to end anastomosis. The 3D models were found to be useful for preoperative planning of the incision site in the trachea, the status of the tracheal and laryngeal framework, the length of the diseased segment, and the length of the rib cartilage graft to be harvested.

Conclusions
The preliminary results of this study imply that 3D models can be useful for preoperative planning of open laryngotracheal surgery. Further experience is required to establish its efficacy, the optimal model design, and cost effectiveness.
DOZ047.78: Endoscopic management of symptomatic tracheal pouches with trichloroacetic acid chemocauterization
Authors: Laín A , Giné C , García L , Barila P , López M 
Published: June 2019

Abstract

Introduction
Trichloroacetic acid (TCA) has been used in different conditions such as recurrent and congenital tracheoesophageal fistula and branchial sinus of the pyriform fossa. Nevertheless, it has never been described as a treatment for symptomatic tracheal pouches after an esophageal atresia repair. This study reports two cases of endoscopic treatment with TCA of symptomatic residual tracheal pouches in 2 children with repaired type III esophageal atresia.

Case Reports
Two cases of 7 and 8 years with esophageal atresia type III repaired in the neonatal period. Both were diagnosed with severe tracheomalacia and presented recurrent pulmonary infections complicated with pulmonary bronchiectasis. One of the patients benefited from a Nissen fundoplication due to severe gastroesophageal reflux at 2 years of life. Due to persistent respiratory infections bronchoscopy was indicated detecting a blind 2 cm tracheal pouch at the level of the carina in both patients.
Endoscopic treatment by the use of TCA was performed. By rigid bronchoscopy chemo-cauterization of the pouch with 50% TCA followed by a brush abrasion of the mucosa was done. Postoperatively one of the patients developed a slight and limited subcutaneous and mediastinal emphysema due to postoperative cough. No other complications were reported. Endoscopic control at 3 months (and also 12 in 1 case) after procedure showed complete obliteration of the tracheal pouches. After a medium follow-up of 17.5 months (14 and 21) a significant decrease in the number of respiratory infections and hospital admissions has been observed in both cases.

Conclusion
Endoscopic treatment by the use of 50% TCA in symptomatic tracheal pouches seems safe and effective. The complex surgical corrections of these conditions make it a perfect indication, representing a minimally invasive alternative.
DOZ047.80: Whole lung lavage for pulmonary alveolar proteinosis in children
Authors: Valiyev N , Cerit K K , Erdas M Y , Gokdemir Y , Erdem E , Kiyan G 
Published: June 2019

Abstract

Purpose
Pulmonary alveolar proteinosis (PAP) is a rare cause of chronic interstitial lung disease in children. PAP is characterized by the accumulation of lipoproteins in alveoli. PAP is a heterogeneous disease and occurs in three clinically distinct forms: congenital, secondary, and acquired. Whole lung lavage (WLL) is currently the gold standard for therapy of PAP. This study aimed to describe the technique and results of WLL in two patients with PAP.

Methods
There is no established standard technique in the management of lung lavage in children in the literature. We isolated one lung with an inflated Fogarty balloon and inserted a suction catheter of appropriate size and washed that lung while ventilating the contralateral lung via rigid bronchoscopy.
Case 1: A 2-year-old boy presented with dispnoe, cough and required continuous oxygen supplementation. The patient was diagnosed with congenital PAP confirmed pathologically and genetically. This patient underwent 9 times left-sided and 7 times right-sided WLL during the 39-month period.
Case 2: A 13-year-old boy presented with respiratory distress and required continuous oxygen supplementation. The patient was diagnosed with congenital PAP and confirmed pathologically and genetically. This patient underwent WLL 3 times for left and 3 times for right side during the 13-month period.
Both cases showed significantly decreased oxygen support and radiological improvement after WLL. But WLL did not provide a definitive treatment for either patient. No significant acute or long-term complication was observed.

Conclusions
We suggest that repeated WLL is an effective but not definitive treatment of PAP. The technique we used is safe and effective because it enables direct visualization of both main bronchi, allowing early recognition of any possible catheter dislocation and eliminating the risk of contralateral lung contamination.