Should All Babies With Oesophageal Atresia Have Routine Screening For Midgut Malrotation Anomalies? A Systematic Review In Search Of Evidence
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In brief
In brief
Systematic review examining malrotation incidence in newborns with esophageal atresia, finding rates of 0.5-13% overall and 10-44% in those with VACTERL association. Authors suggest screening may be warranted given volvulus risk, but call for prospective studies and consensus guidelines on managing asymptomatic malrotation in this population.
Written by the GCMD Library team from the article.
Background/Purpose: Oesophageal Atresia (OA) is associated with co-existent anomalies. There is a controversy of literature pertaining to the risk (s) of intestinal malrotation. In order to guide management we critically evaluate the incidence of IM anomalies in OA newborns.
Design: MEDLINE and EMBASE databases were searched using keywords " (O)Esophageal Atresia and Malrotation/Associated Abnormalities/Associated Anomalies". Full texts of articles were screened if manuscripts exclusively reported patients with OA malrotation and/or associated anomalies. Larger case series (> 10patients) were included if abstract (s) showed that associated anomalies were systematically assessed. Full eligibility criteria required at least one case of malrotation in an OA index case. Data were collected on article type, number of patients and method (s) of diagnosis.
Results: 632 abstracts were screened of which 158 papers were analysed based on inclusion criteria - 30 manuscripts documented the incidence (%) of malrotation. Incidence rate (s) were 0.5% - 13%. Malrotation was observed to have a higher incidence (10% - 44%) in OA babies with other gastrointestinal anomalies (VACTERL).
Conclusion: Newborns with OA appear to be at a higher risk (%) of having intestinal malrotation anomalies than healthy babies. Prospective studies are required to accurately quantify and define the ‘ true incidence ‘ of this association. Given the potential lethal consequences of midgut volvulus screening may be justified in OA babies. Consensus guidelines (DELPHI) exploring surgeons attitudes with regards management of ‘ asymptomatic malrotation ‘ disorders in OA newborns may further guide best practice.