ORIGINAL ARTICLE V. Tomaselli Æ M.L. Volpi Æ C.A. Dell’Agnola M. Bini Æ A. Rossi Æ A. Indriolo Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia Accepted: 15 February 2002 / Published online: 14 November 2002 Ó Springer-Verlag 2002 Abstract Dysphagia, gastroesophageal reflux (GER) and esophageal metaplasia are reported with various incidence in the long term follow-up of patients treated at birth for esophageal atresia (EA). To evaluate the long term outcomes 26 patients treated at birth for EA with Tracheo Esophageal Fistula (TEF) were examined 8–28 (mean 15.8) years later by clinical evaluation, in- cluding barium meal, fiberoptic upper GI endoscopy, 24 hour ambulatory two-channel pH-monitoring and sta- tionary esophageal manometry. 50% of patients com- plained of dysphagia. Mild esophagitis was found in 20% of patients but GER was detected in only 16.7% of the cases. By morphological X-ray, esophageal anoma- lies were detected in 31% of cases without significant functional relevance. Hundred percent of patients had a disorganized peristaltic esophageal activity and a low amplitude of the esophageal contractions was observed in 58% of them. In our series, esophageal dismotilty seems to be the main consequence of EA without any relevant disturbance of normal nutritional habit. Keywords Dysphagia Æ Gastroesophageal reflux Æ Esophageal atresia Æ Tracheo esophageal fistula Introduction The great majority of babies born with Gross’s C type esophageal atresia (EA) are operated on with success in the neonatal period. Even though a good re-establishment of the continuity of the esophagus can be acheived by primary end-to-end anastomosis, other problems related to EA may interfere with normal life in this group of patients. Dysphagia, gastroesophageal reflux(GER) and esophageal metaplasia are present at various levels in all series reported [1, 8, 10]. All these sequelae cause serious impairment to the quality of daily nutritional habits. This study was designed to evaluate the long term impact of EA in a group of patients treated at birth in our hospital by primary correction of EA with Tracheo-Esophageal fistula (TEF). Patients and methods Twenty-six patients (were recurited for this study) from among 79 successful primary esophageal anastomosis performed at birth on babies affected by EA with TEF in the Department of Pediatric Surgery of Niguarda Ca` Granda Hospital. Age at control was between 7–28 years (mean 15.8 years). We selected patients old enough to cope with the quite invasive set of procedures. The following set of tests was performed on all patients: 1. Clinical evaluation focused on esophago-gastric functions with particular attention to detection of the symptoms of GER and to checking the patient’s eating and swallowing behavior. 2. Upper GI X-ray evaluation in order to detect anatomical features of the repaired esophagus and at the same time to study the esophago-gastric junction. 3. Fiberoptic esophagogastroduodenoscopy performed under ambulatory sedation. Particular attention was paid to the site of anastomosis, and also to the detection and sampling of any mu- cosal abnormality. Careful study of the lower esophagus and the cardia was attempted. The severity of esophagitis was graded endoscopically (0–4) according to the modification of the original Savary and Miller classification [6]. 4. Esophageal manometry was carried out with a 8-lumen standard manometric catheter (type AMC8-A, Synetics Medical, USA), with four radial openings at 90° from each other, and the remaining four spaced 5 cm apart. The lumina were perfused with bubble-free distilled water at a constant rate of 0.6 ml/min by a low-compliance pneumohydraulic system (Arndorfer Medical Specialities, USA), and in turn connected through physiological pressure transducers to a multichannel polygraph recorder (paper speed: 1 mm/sec). At the above perfusion rate, the system yields a pressure rise to distal occlusion of more than 300 mmHg/sec. After an overnight fast, the lubricated catheter was inserted within the stomach, and then slowly retracted in 0.5–1 cm increments to Pediatr Surg Int (2003) 19: 40–43 DOI 10.1007/s00383-002-0887-z V. Tomaselli (&) Æ M.L. Volpi Æ C.A. Dell’Agnola Department of Pediatric Surgery, Niguarda Ca’ Granda Hospital, Milan, Italy E-mail: vpatom@libero.it Tel.: ++39-02-64442240 Fax: ++39-02-64442954 M. Bini Æ A. Rossi Æ A. Indriolo Unit of Gastroenterology and Digestive Endoscopy, Niguarda Ca’ Granda Hospital, Milan, Italy V. Tomaselli Via Vettabbia, 6, 20122 Milano, Italy