EN
TÜRKÇE
Oral Presentation - 44
Comparison of proactive vs reactive endoscopic approaches for surveillance in patients post-esophageal atresia repair
C Sanon, JE Frias Mantilla, H Bacha, A Bouragbi, AM Sant'Anna
McGill University, Montreal, Canada
Objectives
The advantage of routine endoscopic surveillance and dilatation in esophageal atresia (EA) patients, compared to selective endoscopy and dilatation for symptomatic patients remais controversial. This study aims to evaluate the outcomes of these two approaches in our patient population.
Methods
We analyzed two groups of patients followed for up to 36 months post-EA repair (n=24). The proactive group (n=13) underwent routine and symptom-driven endoscopic surveillance from February 2016 to February 2019, with dilatations performed as needed. The reactive group (n=11), managed from February 2020 to February 2023, received selective endoscopies only when symptomatic. Follow-up strategies were determined based on the year of treatment. Variables (type of EA, age, lenght of gap, presence of strictures and number of endoscopies/dilatations) were studied.
Results
In the proactive group, 78 endoscopies were performed with 59 required dilatations (75.64%). In the reactive group, we had 47 endoscopies, with 46 dilatations (97.87%). The mean number of endoscopic interventions per patient was 6 in the proactive group and 4.27 in the reactive group, with similar mean numbers of dilatations per patient: 4.53 in the proactive group and 4.18 in the reactive group. The odds ratio (OR) for comparing the effectiveness of endoscopies in detecting patients requiring dilatations between the reactive and proactive groups was approximately 14.81. This difference suggests the increased likelihood in the reactive group of requiring dilatations compared to the proactive approach. The most common finding in both groups was stricture. There were two complications (leakages) in the proactive group.
Conclusions
The reactive approach reduced the number of endoscopic procedures needed in our population. Patients who had a reactive follow-up were more likely to require dilatation therapy. This small study suggests that a reactive strategy can decrease the frequency of anesthetic exposure, risk and procedural costs by reducing the number of endoscopic events in patients who do not require dilatation.