APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso
With Dr. Catherine LaRusso & Dr. Miguel Guelfan · hosted by Dr. Em Gootee · StayCurrentMD
Cued at 3:40 · stops at 4:25 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Due to recent studies implicating transanastomotic feeding tubes as an independent risk factor for postoperative strictures, Montreal Children's Hospital initiated a moratorium on their use until evaluating their own outcomes.
The study included all type C and type D EA-TEF patients at three university-affiliated hospitals in Quebec over 25 years (1993-2018) who had primary repair within 6 months of birth and at least 1 year follow-up.
Stricture was defined as symptoms with imaging confirmation (upper GI or endoscopy) at one year.
Of 371 EA-TEF patients born during the study period, 344 were type C or D, and 244 were included in the analysis.
About 30% of patients had strictures, and transanastomotic tubes were used in 61% of patients.
On univariate analysis, transanastomotic tubes were significantly associated with strictures.
On multivariate analysis adjusting for gestational age, leak, long gap, anastomotic tension, and daily acid suppression, transanastomotic tubes conferred almost 3 times higher odds of developing a stricture compared to those without.
Days on postoperative TPN were the same between transanastomotic tube and non-tube groups; all patients in the study cohort were on TPN.
Days to first enteral feeding were shorter in the transanastomotic feeding tube group than those without.
Transanastomotic feeding tubes are associated with an increased rate of postoperative strictures, decreased time to enteral feeding, but do not confer a major benefit in the number of days on postoperative TPN.
In the study data, only about 30 cases were done thoracoscopically out of 244 patients, so numbers are not large enough to definitively say whether MIS techniques impact stricture rates.
One standard type of tube was used as a transanastomotic feeding tube in the study.
Data on replacement tubes when children fail oral enteral feeding is difficult to analyze retrospectively and needs to be captured in future studies with more randomization.
Transanastomotic tubes potentially increase inflammation and acid exposure to the anastomosis, increasing stricture rate overall.
Risk factors for the development of post-operative stricture in EA-TEF include anastomotic tension, long gap atresia, leak, gastroesophageal reflux, and more recently, trans anastomotic tubes have been implicated.
Use of transanastomotic tubes has increased since the 1980s, the rationale being a shorter time to feeds and a shorter duration of postoperative TPN.
A recent Midwest Pediatric Surgery Consortium study of 292 type C EA-TEF patients found an increased rate of strictures in the transanastomotic tube group that was almost 2 times that of those without.
A Children's Hospital of Pittsburgh study of EA-TEF (all types, majority type C) found a significant difference in stricture rates between transanastomotic tube and non-tube groups.