Anastomotic Stricture Definition After Esophageal Atresia Repair: Role of Endoscopic Stricture Index

Abstract

BackgroundTo evaluate the feasibility and efficacy of endoscopic stricture index (SIEN) to define anastomotic strictures (ASs) and to predict the need of dilatations. Materials and methodsA retrospective longitudinal study was conducted on patients who underwent esophageal atresia repair from 1998-2020 (ethical committee approval CHPED-05-20-AS). SIEN was calculated on the first endoscopy performed as follows: (D − d)/D, where D is the maximum diameter of lumen of the upper esophagus close to the AS and d is the diameter of lumen of the stricture. Nonparametric variables were examined using Wilcoxon-Mann-Whitney test, and continuous variables were analyzed using Spearman's test and regression analysis. A P value <0.05 was considered statistically significant. The sensitivity, specificity, and positive and negative predictive values of SIEN were also calculated, and a receiver operating characteristic curve was designed. ResultsA total of 46 patients were included in the study. A statistically significant correlation was found between SIEN and number of dilations (Spearman's correlation rate, 0.7; P < 0.0005). A SIEN threshold value ≥0.6 showed sensitivity of 100%, specificity of 80%, positive predictive value of 54%, negative predictive value of 100%, and the area under the curve of 84%. ConclusionsSIEN seems to be a good AS definer and prognostic tool; our study suggests that an AS could be defined by a SIEN ≥0.6.