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Foust AM, Zendejas B, Mohammed S, Meisner J, Zurakowski D, Staffa SJ, Jennings RW, Hamilton TE, Callahan MJ. Radiographic assessment of traction-induced esophageal growth and traction-related complications of the Foker process for treatment of long-gap esophageal atresia. Pediatr Radiol 2022; 52:468-476. [PMID: 34845501 DOI: 10.1007/s00247-021-05228-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/19/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Radiographic assessment of esophageal growth in long-gap esophageal atresia while on traction and associated traction-related complications have not been described. OBJECTIVE To demonstrate how chest radiography can estimate esophageal position while on traction and to evaluate radiography's utility in diagnosing certain traction system complications. MATERIALS AND METHODS In this retrospective evaluation of portable chest radiographs obtained in infants with long-gap esophageal atresia who underwent the Foker process between 2014 and 2020, we assessed distances between the opposing trailing clips (esophageal gap) and the leading and trailing clips for each esophageal segment on serial radiographs. Growth during traction was estimated using longitudinal random-effects regression analysis to account for multiple chest radiograph measurements from the same child. RESULTS Forty-three infants (25 male) had a median esophageal gap of 4.5 cm. Median traction time was 14 days. Median daily radiographic esophageal growth rate for both segments was 2.2 mm and median cumulative growth was 23.6 mm. Traction-related complications occurred in 13 (30%) children with median time of 8 days from traction initiation. Daily change >12% in leading-to trailing clip distance demonstrated 86% sensitivity and 92% specificity for indicating traction-related complications (area under the curve [AUC] 0.853). Cumulative change >30% in leading- to trailing-clip distance during traction was 85% sensitive and 85% specific for indicating traction complications (AUC 0.874). CONCLUSION Portable chest radiograph measurements can serve as a quantitative surrogate for esophageal segment position in long-gap esophageal atresia. An increase of >12% between two sequential chest radiographs or >30% increase over the traction period in leading- to trailing-clip distance is highly associated with traction system complications.
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Affiliation(s)
- Alexandra M Foust
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | | | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, Boston, MA, 02115, USA
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Tambucci R, Wautelet O, Haenecour A, François G, Goubau C, Scheers I, Halut M, Menten R, Schmitz S, de Toeuf C, Pirotte T, D'hondt B, Reding R, Poncelet A. Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report. Front Pediatr 2020; 8:605143. [PMID: 33330293 PMCID: PMC7714922 DOI: 10.3389/fped.2020.605143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called "esophageal trachea," which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions.
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Affiliation(s)
- Roberto Tambucci
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Océane Wautelet
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Astrid Haenecour
- Pediatric Intensive Care Unit, Emergency Department, Saint-Luc University Clinics, Brussels, Belgium
| | - Geneviève François
- General Pediatric Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Christophe Goubau
- Pediatric Pneumology Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Isabelle Scheers
- Pediatric Gastroenterology and Hepatology Unit, Department of Pediatrics, Saint-Luc University Clinics, Brussels, Belgium
| | - Marin Halut
- Pediatric Radiology Unit, Department of Radiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Renaud Menten
- Pediatric Radiology Unit, Department of Radiology, Saint-Luc University Clinics, Brussels, Belgium
| | - Sandra Schmitz
- Otolaryngology Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Caroline de Toeuf
- Otolaryngology Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Thierry Pirotte
- Pediatric Anesthesiology Unit, Emergency Department, Saint-Luc University Clinics, Brussels, Belgium
| | - Beelke D'hondt
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Raymond Reding
- Pediatric Surgery and Transplantation Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
| | - Alain Poncelet
- Pediatric Cardiac and Thoracic Surgery Unit, Department of Surgery, Saint-Luc University Clinics, Brussels, Belgium
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