Clinical yield of esophagogastroduodenoscopy and pH-impedance testing in esophageal atresia patients performed according to international guidelines.

Abstract

According to the European Society for Paediatric Gastroenterology Hepatology And Nutrition & North American Society For Pediatric Gastroenterology, Hepatology And Nutrition (ESPGHAN-NASPGHAN) guideline, esophageal atresia (EA) patients should routinely undergo esophagogastroduodenoscopy (EGD) with biopsies and/or pH-impedance (pH multichannel intraluminal impedance test; pH-MII) for surveillance purposes. It is additionally recommended to perform these procedures when there is a clinical indication: symptoms suggestive of gastroesophageal reflux disease or eosinophilic esophagitis. The aim of this study was to evaluate how often EGD/pH-MII outcomes change management decisions in EA children who come for surveillance and/or for clinical evaluation of their symptoms. A retrospective chart review was conducted of all EA patients who received EGD and/or pH-MII for routine surveillance or because of clinical indication, i.e. symptoms suggestive of gastroesophageal reflux disease or eosinophilic esophagitis. For each procedure, we assessed whether outcomes changed management decisions. Between 2017 and 2020, 41 patients (median age 2.0 [1.0-17.5] years) underwent EGD/pH-MII for surveillance purposes and 64 (3.0 [0.1-15.8] years) for symptom evaluation. Of the 41 patients who underwent surveillance EGD/pH-MII, 18 (43.9%) were asymptomatic when interviewed. Eight of these 18 (44.4%) had results that changed management decisions. In total, 23/41 (56.1%) had results that changed management decisions. Sixty-four patients presented clinically with (a combination of) dysphagia (n = 50; 78.1%), regurgitation (n = 37; 57.8%), heartburn (n = 18; 28.1%), and/or respiratory symptoms that were thought to have a gastrointestinal origin (n = 24; 37.5%). Results changed management decisions in 34/64 (53.1%) patients who presented with symptoms. There is a high clinical yield of EGD and pH-MII testing in EA patients. More than half of the patients, regardless of indication (routine surveillance or symptom evaluation), had EGD and/or pH-MII results that changed management decisions.

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