O2086: Current Esophageal Surveillance Practice in Esophageal Atresia Patients

Purpose/Objectives: Current guidelines for esophageal endoscopic surveillance after esophageal atresia (EA) repair rely primarily on expert opinion, limited studies and are not well-standardized. This study sought to understand current esophageal surveillance opinions and practices among pediatric surgeons and gastroenterologists within a large pediatric surgery research consortium. If surveillance is not routine, associated comorbidities may be asymptomatic and escape detection.

Design/Methods: A 23-question survey was distributed to 178 physicians at 17 institutions (158 pediatric surgeons and 20 gastroenterologists). A series of multiple-choice questions assessed frameworks for multi-disciplinary follow-up, as well as timing and method(s) of esophageal surveillance. Likert scale questions ascertained agreement with EA care statements based on published ESPGHAN/NASPGHAN guidelines. Institutional IRB approval 20-050.

Results: The overall response rate was 62% (64% of pediatric surgeons and 45% of gastroenterologists). Years in practice ranged from less than 5 (31%), 5-10 (26%), and greater than 10 years (43%). The majority of institutions (61%) report performing 10-20 EA repairs annually.

Over 77% of respondents agreed or strongly agreed with each ESPGHAN/NASPGHAN guideline. Yet few incorporate these recommendations into their practices (Figure 1). Seventy percent report conducting post-operative surveillance, but method(s) vary among clinical assessment (86%), endoscopy (48% with and 23% without routine biopsy), pH-impedance monitoring (15%). Upper endoscopy is performed in EA patients routinely, regardless of symptoms, in 35% of practices (Figure 2). Many (45%) note performing the first endoscopy only if symptoms are present, while 23% perform endoscopy at one year of age and twice more before transitioning to adult care.

Nearly 10% of physicians report that their current surveillance practice does not meet a desirable standard of care. Most institutions have an aerodigestive clinic (77%), yet only half have a dedicated multi-disciplinary team to follow EA patients. Furthermore, the majority of physicians are willing or potentially willing (77 and 19%, respectively) to incorporate new evidence-based guidelines into their practice; 72% expressed strong interest in helping to develop these guidelines.

Conclusion/Discussion: Our survey reveals substantial agreement with ESPGHAN/NASPGHAN esophageal surveillance guidelines across regional consortium member institutions, yet implementation is inconsistent. There is a lack of consensus regarding the method and timing of esophageal surveillance, which underscores the need for high quality data to guide longitudinal EA care.

The providers surveyed strongly support creation of evidence-based EA management guidelines. A majority of consortium member institutions have an existing aerodigestive clinic that could provide a framework for a multidisciplinary team for esophageal surveillance and drive adoption of evidence-based surveillance practices by pediatric surgeons.

This study describes current practices for esophageal surveillance, which highlights the need to develop standardization and implement evidence-based practice guidelines across institutions. We hope to address these needs in future phases of our study as we quantify and follow longitudinal disease burden in EA.