Anastomotic Stricture Definition After Esophageal Atresia Repair: Role of Endoscopic Stricture Index Giovanni Parente, MD,* Tommaso Gargano, MD, Giovanni Ruggeri, MD, Michela Maffi, MD, Simone D’Antonio, MD, Elisa Sacchet, MD, and Mario Lima, MD Department of Pediatric Surgery, Sant’Orsola-Malpighi University Hospital, Bologna, Italy article info Article history: Received 10 June 2020 Received in revised form 30 July 2020 Accepted 3 August 2020 Available online xxx Keywords: Anastomotic strictures Esophageal atresia Esophageal endoscopic dilatations Stricture index abstract Background: To evaluate the feasibility and efficacy of endoscopic stricture index (SI EN ) to define anastomotic strictures (ASs) and to predict the need of dilatations. Materials and methods: A retrospective longitudinal study was conducted on patients who underwent esophageal atresia repair from 1998-2020 (ethical committee approval CHPED- 05-20-AS). SI EN 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 SI EN were also calculated, and a receiver operating characteristic curve was designed. Results: A total of 46 patients were included in the study. A statistically significant corre- lation was found between SI EN and number of dilations (Spearman’s correlation rate, 0.7; P < 0.0005). A SI EN 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%. Conclusions: SI EN seems to be a good AS definer and prognostic tool; our study suggests that an AS could be defined by a SI EN 0.6. ª 2020 Elsevier Inc. All rights reserved. Introduction Nowadays the esophageal atresia (EA) repair, if performed in proper pediatric centers, has great results in terms of safety and survivance (even more than 95%, depending on the se- ries) 1,2 that leads pediatric surgeons and pediatric gastroen- terologists to face late complications related to both the surgical operation and the intrinsic characteristics of the malformation itself; the anastomotic stricture (AS) is certainly one of them. The reported incidence of AS varies from 9%-80% according to the different studies 3-10 and can be managed by an endo- scopic dilatation program. The worst ASs do not respond to di- lations and another surgical procedure is needed to solve them. Although dilatation techniques are well standardized, literature lacks a reliable AS definition and classification to guide pediatric surgeons’ behavior. Recently, a parameter called stricture index (SI) was pre- sented in the literature as a good classification and prognostic tool for AS. The aim of the present study was to verify if the SI * Corresponding author. Pediatric Surgery Department, Sant’Orsola-Malpighi University Hospital, via Massarenti 9, 40138 Bologna, Italy. Tel.: þ39 051 214 4656; fax: þ39 051 214 4619. E-mail address: giovanni.parente@outlook.com (G. Parente). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  january 2021 (257) 572 e578 0022-4804/$ e see front matter ª 2020 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2020.08.035