Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
Timestops (6)
Tools Used
Topic Overview
Key Takeaways
- Glycopyrrolate reduced chest tube output by 66% (124mL vs 370mL) in EA anastomotic leak patients compared to placebo.
- Leak resolution achieved in 76% of glycopyrrolate group vs only 29% of placebo group in this RCT of 42 patients.
- Oral feeding success was 5x higher with glycopyrrolate (71% vs 14%), suggesting earlier return to enteral nutrition.
- 14% leak rate after EA repair in this series; glycopyrrolate offers evidence-based adjunct for this common complication.
- Randomized controlled design with blinded observer and clinically significant outcomes supports practice change consideration.
Keywords
Hashtags
Transcript
This is Todd Ponsky from the Journal of Pediatric Surgery, and today we have a guest reviewer, Doctor Abdul Raoof Lamoshi. Raoof, thanks for joining us. Thank you, Todd. Raoof is a research fellow here at Akron Children's Hospital, and today he reviewed a great paper. The title of today's article is Role of Glycopyrolate in Healing of Anastomotic dehiscence after Primary Repair of esophageal atresia in a Low Resource setting, a randomized control study. The first author on this paper was Doctor Vela. This was a prospective randomized control trial studying the effect of glycopyrolate on patients that had leak after oesophageal atresia repair. There were 297 patients over a 10 year period that underwent esophageal atresia repair. Of the 297, there were 42 leaks. That's about 14%. They then prospectively randomized the 42 patients into two groups, 21 each, the one group receiving glycopyrrolate and the other group receiving placebo, which was saline. The observer was blinded to which treatment group the patient was in. And Raouf, what were the results? So the main explored variables were chest tube output, which was 124 mL in the treatment group, compared to 370 mL in the placebo group. Second variable was the leak resolution, which was accomplished in 76% of the treatment group compared to 29% of the placebo group. And oral feeding, which was achieved in 71% of treatment group compared to only 14% of the placebo group. OK, so the results are pretty astounding. The Robinol or the glycopyrolate group really had impressive results compared to the placebo group. But what about the quality of the study? I think this was a very well done study because it's a randomized controlled trial and has a very good. Sample size and the results were both statistically and the clinically significant. Yeah, I agree. I, uh, think this is a great study to review because it's a novel treatment that can have substantial effect on a very complicated problem we all deal with. I know that I'll change my practice based on this and start giving Roben all to my, uh, leaks after TEF repair, but I'm curious what you all would do. So leave your comments below. Thanks for watching, Rove. Thanks for the review. Thank you, Todd, and we'll see you next time.