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Oral Presentation - 20
Stricture classification of pediatric esophageal strictures (SCOPES): the use of a novel stricture classification system to predict response to endoscopic therapy
B Oby*, S Staffa**, P Ngo*, D Chang*, M Manfredi***, J Yasuda*
*Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA
**Department of Anesthesiology, Critical Care, and Pain Medicine; Boston Children’s Hospital, Boston, Massachusetts, United States of America
***The Children's Hospital of Philadelphia, Philadelphia, United States of America
Purpose:
Anastomotic stricture is a common pediatric complication following esophageal atresia (EA) repair, requiring endoscopic therapies such as dilation, intralesional steroid injection, and electrocautery incisional therapy (EIT). Stricture response to these interventions is unpredictable, often necessitating repeated procedures. Existing stricture classification tools focus solely on diameter and lack predictive capability for therapy response. We developed a novel stricture classification tool that considers multiple physical characteristics, and we evaluate its predictive capability in pediatric anastomotic strictures.
Methods:
An IRB-approved retrospective review at Boston Children’s Hospital included 70 pediatric EA patients with at least two endoscopies. Before intervention, the stricture classification tool is used and the endoscopist scores the stricture at the beginning of each endoscopy according to its starting diameter, length, and degree of intrusion of the anastomotic scar band in 4 quadrants around the circumference of the anastomosis. Diameter changes (ΔD mm) between procedures were normalized to follow-up intervals and used to evaluate therapeutic effectiveness.
Results:
Mixed-effects regression analyses were performed. The study included 148 scored endoscopies. Multivariable analyses showed stricture symmetry and scar intrusion were significantly associated with therapeutic effectiveness. Both stricture symmetry and stricture intrusiveness correlated with larger gains in diameter over time (p=0.03, p=0.02, respectively). In an EIT subgroup univariate analysis, starting diameter, steroid injection treatment and symmetry were each associated with significant changes in diameter over time (p=0.001, p=0.01, p<0.001, respectively).
Conclusion:
Understanding the impact of readily ascertainable physical features of stricture on that stricture’s behavior can help clinicians predict how a stricture will respond to endoscopic therapy. Symmetry and scar protuberance emerged as key predictors, highlighting the importance of tools that aid the endoscopist to create personalized treatment strategies for esophageal anastomotic stricture. Further large-scale, prospective randomized studies are needed to confirm these findings.