Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia (OA) Surgery | 1395 Patients | Systematic review Meta-analysis | Cardiff, UK | 753 prophylactic Acid-suppression | 642 No prophylaxis | Prophylaxis group | Increased odds of anastomotic strictures is not statistically significant | (OR 1.33; 95% CI 0.92, 1.92) | No significant difference in... | Reflux Disease | Anastomotic leak | Esophagitis / esophageal erosion | RESULTS | Conclusion: | No significant evidence links preventive acid suppression medication to anastomotic stricture risk after oesophageal atresia repair. | https://www.jpedsurg.org/article/S0022-3468(23)00342-1/ | Source: Wyllie T et.al. | @gigenace | @StayCurrentMD | Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK | Cincinnati Children's | Journal of Pediatric Surgery
Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia Surgery
Infographic · Dec 2023 · 1 min read
In brief
In brief
Systematic review of 1395 patients found no statistically significant benefit of prophylactic acid suppression medication in preventing anastomotic strictures after oesophageal atresia repair. Meta-analysis showed a non-significant trend toward increased stricture odds in treated patients, highlighting the need for randomized controlled trials to guide clinical practice.
- Prophylactic acid suppression after OA/TOF repair showed no significant reduction in anastomotic stricture rates (OR 1.33, 95% CI 0.92-1.92).
- Current evidence for routine acid suppression post-OA repair is limited to observational studies with high risk of bias.
- No significant differences found in secondary outcomes including GORD, anastomotic leak, or oesophagitis with prophylactic treatment.
- A randomized controlled trial is needed to definitively determine if acid suppression prevents strictures after oesophageal atresia repair.
- Consensus guidance recommending routine acid suppression may not be supported by current evidence; practice should be individualized.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, dark teal, and yellow color scheme with a structured layout. The top section displays the title and study overview with a calendar icon. The middle section shows patient distribution with red and yellow arrows pointing to two groups. The results section on the left uses purple text for key findings, accompanied by a medication bottle illustration on the right. The bottom features a yellow conclusion banner.
New infographic by Dr. Cecilia Gigena
"Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia Surgery: A Systematic Review and Meta-analysis"
Authors: Thomas Wyllie, Eniola Folaranmi, Prabhu Sekaran, W John Watkins, Mallinath Chakraborty
Full article: https://gcmd.co/3vi4oCE
Background
Anastomotic stricture is a common postoperative complication of oesophageal atresia ± tracheoesophageal fistula (OA/TOF) repair. Acid gastro-oesophageal reflux disease (GORD) is considered to be a factor in stricture formation and acid suppression medication is recommended post-operatively in consensus guidance. We aimed to investigate whether patients who were treated prophylactically with acid suppression medication had a reduced incidence of strictures compared to those who did not receive it.
Methods
A systematic review of studies was performed, searching multiple databases without language or date restrictions. Multiple reviewers independently assessed study eligibility and literature quality. The primary outcome was anastomotic stricture formation, with secondary outcomes of GORD, anastomotic leak, and oesophagitis. Meta-analysis was performed using a random effects model, and the results were expressed as an odds ratio (OR) with 95% confidence intervals (CI).
Results
No randomised studies on the topic were identified. Twelve observational studies were included in the analysis with ten reporting the primary outcome. The quality assessment showed a high risk of bias in several papers, predominantly due to non-objective methods of assessment of oesophageal stricture and the non-prospective, non-randomised nature of the studies. Overall, 1395 patients were evaluated, of which 753 received acid suppression medication. Meta-analysis revealed a trend towards increased odds of anastomotic strictures in infants receiving prophylactic medication, but this was not statistically significant (OR 1.33; 95% CI 0.92, 1.92). No significant differences were found in secondary outcomes.
Conclusions
This meta-analysis found no evidence of a statistically significant link between the prophylactic prescribing of acid suppression medication and the risk of developing anastomotic stricture after OA repair. The literature in this area is limited to observational studies and a randomised controlled trial is recommended to explore this question.