Impact of digestive-surgical cross-disciplinary management in patients with esophageal atresia.

S Monje Fuente, L Pérez Egido, M A García-Casillas, E Oujo, M Tolín, C Sánchez, S D Israel, I Bada, J Ordóñez, A Del Cañizo, M Fanjul, D Peláez, J Cerdá, J C de Agustín
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Abstract

Objective: The objective of this study was to analyze whether patients undergoing esophageal atresia (EA) surgery benefit from a cross-disciplinary follow-up program, based on current clinical guidelines, implemented in our institution.

Materials and methods: An observational, analytical, retrospective study of patients undergoing EA surgery from 2012 to 2022 was carried out. The results of a joint pediatric surgery and gastroenterology consultation program -which was implemented in 2018 and applies a protocol based on the new ESPGHAN-NASPGHAN guidelines- were analyzed. Patients were divided according to whether they had been treated before or after 2018. Quantitative variables -follow-up losses, anti-reflux treatment initiation and duration, and enteral nutrition initiation- and qualitative variables -prevalence of gastroesophageal reflux, anti-reflux surgery, respiratory infections, anastomotic stenosis, re-fistulizations, dysphagia, impaction episodes, need for gastrostomy, and endoscopic results- were compared.

Results: 38 patients were included. 63.2% had gastroesophageal reflux. 97.4% received anti-reflux treatment in the first year of life, with treatment being subsequently discontinued in 47.4%. Discontinuation time decreased by a mean of 24 months following program implementation (p< 0.05). A 4.6-fold increase in the frequency of pH-metries was noted following program implementation. The protocol standardized endoscopies in asymptomatic patients when they turn 5 and 10 years old. 25 endoscopies with biopsy were carried out after 2018, with histological disorders being detected in 28% of them. The number of follow-up losses significantly decreased following protocol implementation (p< 0.05).

Conclusions: Digestive-surgical cross-disciplinary follow-up of EA patients has a positive impact on patient progression. Applying the guidelines helps optimize treatment and early diagnosis of complications.

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消化外科跨学科管理对食管闭锁患者的影响。
目的:本研究的目的是分析接受食管闭锁(EA)手术的患者是否受益于我们机构根据当前临床指南实施的跨学科随访计划。材料和方法:对2012年至2022年接受EA手术的患者进行了观察性、分析性、回顾性研究。对2018年实施的儿科手术和胃肠病联合咨询计划的结果进行了分析,该计划采用了基于新的ESPGHAN-NASPGHAN指南的方案。根据患者在2018年之前或之后是否接受过治疗对患者进行了分组。比较了定量变量(随访损失、抗反流治疗的开始和持续时间、肠内营养的开始)和定性变量(胃食管反流的发生率、反流手术、呼吸道感染、吻合口狭窄、再造瘘、吞咽困难、嵌塞发作、胃造瘘的需要和内镜检查结果)。结果:纳入38例患者。胃食管反流占63.2%。97.4%的患者在生命的第一年接受了抗反流治疗,47.4%的患者随后停止治疗。计划实施后,停止治疗的时间平均缩短了24个月(P结论:EA患者的消化外科跨学科随访对患者的进展有积极影响。应用指南有助于优化并发症的治疗和早期诊断。
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