[size=20px]A 10 year old boy with a history of esophageal atresia with a distal tracheoesophageal fistula presents for routine follow up. He has no symptoms of dysphagia or heartburn and is in the normal percentile for growth. Which of the following should be recommended at this point?

 

A observation

 

B esophagram

 

C CT scan

 

D MRI

 

E Endoscopy[/size]

E

correct answer

E Endoscopy

 

The long-term management of esophageal atresia (EA) patients has been evolving as there are increasing numbers of survivors. The concerns for older children and young adults revolve around dysphagia, gastroesophageal reflux and its complications, and growth issues. In 2016, the European and North American societies of Pediatric Gastroenterology (ESPGHAN and NASPGHAN) published a comprehensive consensus statement on evaluation and treatment for these patients. These guidelines were based on members selected from both gastroenterology societies as well as pediatric surgeons, and each member voted on the strength of the recommendation based on the available evidence after a systematic review. One of the main recommendations was evaluation of the esophagus for any effects of chronic GER – esophagitis, stricture, Barrett’s changes, dysmotility - and an algorithmic approach was recommended. The consensus opinion recommended routine surveillance endoscopy to be performed at the time that acid suppression therapy is stopped, at the age of 10, and at the time the patient is transitioned to adult providers. This recommendation was to be followed even in asymptomatic patients, as silent GER may lead to changes that can progress and require active interventions. Treatment plans for patients with esophagitis were divided into PPI use, consideration for antireflux procedures, or promotility agents. The algorithms also included other management strategies based on other causes of esophagitis, such as eosinophilic.

 

Edited September 8, 20233 yr by Admin

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