Esophageal Atresia in Asia: Regional Disparities in Incidence, Congenital Anomalies, Mortality, and Morbidity - A Systematic Narrative Review.

Abstract

Background: Esophageal atresia (EA), with or without tracheoesophageal fistula, remains associated with substantial early mortality and long-term morbidity. Reported incidence and outcomes vary across Asia, but interpretation is complicated by differences in case capture, referral pathways, diagnostic capacity, and neonatal intensive care availability.

Methods: We performed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-aligned systematic narrative review of observational studies from Asian countries published up to March 2024 (PubMed and Google Scholar). Studies reporting incidence, associated anomalies, morbidity, or mortality were included. Findings were synthesized descriptively and presented stratified by study base (population-based vs. hospital-based) and resource setting (World Bank income proxy). Risk of bias was assessed using a generic domain-based framework (D1-D6).

Results: Thirty-four studies (3304 infants) were included. Six population-based studies reported incidence ranging from 6.17 to 20.30 per 100,000 live births. Hospital-based reports documented 921 associated anomalies, most commonly gastrointestinal (36%) and cardiovascular (27%). Mortality across 19 cohorts ranged from 2% to 83%. Morbidity profiles differed by setting: in higher-resource cohorts, reported events were dominated by gastroesophageal reflux and anastomotic stricture, whereas in lower-resource cohorts, septicemia (47% of events) and wound infection (10%) were prominent.

Conclusion: EA incidence in Asia is within international ranges, but published outcomes vary widely and should be interpreted descriptively given referral and ascertainment differences, variable anomaly detection, heterogeneous definitions, and limited follow-up. Priorities include strengthening prenatal detection and referral, improving neonatal stabilization and safe transport, standardizing perioperative care with infection prevention, and establishing feasible long-term follow-up supported by a pragmatic action framework.