DOZ047.97: Anastomotic strictures in patients with oesophageal atresia systematically treated with PPI: prospective cohort study over 10 years
Bibliographic record
Abstract
Abstract Objectives and Study Clinical course in oesophageal atresia (OA) patients is frequently complicated by gastroesophageal reflux disease, which is thought to be a risk factor for formation of anastomotic strictures. It is currently recommended that OA patients be treated systematically with proton pump inhibitors (PPI) after surgical repair. However, it is not clear if PPI treatment does really prevent the formation of anastomotic strictures and reduce the incidence of histological complications during long-term follow up. This study aimed to describe the outcomes of a cohort of OA patients with or without tracheoesophageal fistula (TOF) systematically treated with PPI since the neonatal period. Method Prospective longitudinal cohort study over 11 years of 73 children with OA-TOF, systematically treated with PPI, was carried out. Descriptive data is presented as median (interquartiles) for continuous variables and as frequency (%) for categorical variables. Pearson's χ2 test, Fisher's exact test, and Wilcoxon rank sum test were used for univariate analysis. SAS software, version 9.3 (SAS Institute, Cary, NC) was used; P-values < 0.05 were considered statistically significant. Results Seventy-three patients (41 males) were included in the final analysis. The median age at study completion was 4.87 years (3.64, 7.97; range 1–11.4). According to Gross classification, 64 patients (88%) had OA type C, 8 (11%) had type A, and 1 (1%) had type D; long-gap OA was present in 16 patients (22%). Thoracotomy was performed in 56 patients and thoracoscopy in 17. Anastomotic strictures and recurrent strictures were diagnosed in 32 (44%) and 17 patients (23%), respectively. In all but one case, strictures occurred when the child was on PPI. Anastomotic strictures occurred significantly more frequently in long-gap OA, in patients with anastomotic leak after surgical repair and longer hospital stay (P = 0.02, 0.002, and 0.02 respectively). Histological complications, especially gastric metaplasia, appeared more frequently in OA patients with anastomotic strictures (P = 0.01). Conclusion Forty-two percent of patients developed anastomotic strictures on PPI treatment, therefrom 55% patients with recurrent anastomotic strictures, indicating that acid gastroesophageal reflux seems not to be the major trigger factor for developing anastomotic strictures. A more selective prescription of PPI should be discussed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".