DOZ047.113: Outcome of routine esophagogastroduodenoscopy, high-resolution manometry (HRM), and pH-(impedance) measurement in esophageal atresia patients according to international guidelines

Abstract

Abstract Background Evidence-based guideline recommendations for follow-up of patients with esophageal atresia (EA) include regular surveillance esophagogastroduodenoscopy (EGD) with biopsies and a pH(-impedance) measurement (pH-MII) to evaluate gastroesophageal reflux disease (GERD) in asymptomatic patients. In addition, high-resolution manometry (HRM) is considered useful to assess esophageal dysmotility. Additional testing is recommended when symptoms are present. Our aim was to evaluate the diagnostic and clinical yield of these tests. Methods All EA patients who underwent EGD, pH-MII, and HRM according to EA guideline recommendations in 2017 and 2018 were included. Results Seventy-eight patients (53% male, 78% type C, median age 5 (0–17) years) were included. Thirty-one patients had EGD (n = 30), pH-MII (n = 11), and/or HRM (n = 7) as part of a routine surveillance program. Forty-seven patients had EGD (n = 47), pH-MII (n = 26), and HRM (n = 9) for symptom evaluation. Symptoms at the time of testing included dysphagia (51%), regurgitation (41%), and heartburn (24%). Results and consequences of the surveillance and clinically indicated tests are shown in Tables 1 and 2, respectively. Macroscopic EGD findings included stricture (21%), signs of eosinophilic esophagitis (EoE, 3%), and signs of reflux esophagitis (3%). Histological findings included EoE (13%) and reflux esophagitis (17%). Clinical implications of EGD results included medication alteration (GERD/EoE), esophageal dilation, antireflux surgery, or diet change. MII-pH was performed in 37 patients; 15 (41%) were on acid suppressive medication during measurement. Clinical implications of MII-pH results were: start or adjustment of acid suppressive therapy (30%), start or increase of other medication (22%), ceasing of acid suppressive therapy (14%), and referral for fundoplication (3%). HRM was performed in 16 patients (21%, n = 2 uninterpretable due to continuous crying) and showed absent peristalsis in 8/14 (50%), ineffective peristalsis in 4/14 (25%), and fragmented peristalsis in 2/14 patients (12.5%). Clinical implications of manometry results included referral for contrast esophagram (n = 1), increased gastrostomy feeding (n = 1), and gastrostomy placement (n = 1). Conclusion EGD, MII-pH, and HRM reveal multiple abnormalities that have clinical consequences when performed as per recommended surveillance guidelines, which highlights their importance. In most symptomatic patients, additional testing demonstrates underlying pathology. Abnormal diagnostic tests can help guide clinical management in asymptomatic and symptomatic EA patients.