Acid suppression after esophageal atresia repair: Some infants do benefit.

Background: Acid suppression is used to protect against anastomotic strictures after esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, but recent studies have contested this benefit. We aimed to compare rates of anastomotic stricture following EA/TEF repair among patients who received and did not receive acid suppression in a nationwide sample.

Methods: We queried the Pediatric Health Information System for infants undergoing EA/TEF repair between 2010 and 2022. Acid suppression was defined as receipt of an H2 blocker or proton pump inhibitor on the day of discharge or longer than 30 inpatient days. Complex EA/TEF repair was defined as delayed repair (>7 days), G-tube placement before repair, prolonged hospitalization (>60 days), or multiple inpatient fluoroscopies. Stricture dilation defined the outcome.

Results: Of 1445 infants included from 47 hospitals, 257 (17.8%) required dilation by 1 year. Of the 688 (47.6%) infants who met criteria for complex EA/TEF, 126 (18.6%) required a dilation. Prolonged acid suppression was given in 977 (67.6%) infants. At 1 year, stricture rate was similar in infants with simple EA/TEF, with or without acid suppression (17.5% vs. 17.0%, p = 0.90), however, in infants with complex EA/TEF, stricture rates were lower among those who received acid suppression compared to those who did not (15.3% vs. 26.0%, p = 0.001).

Conclusion: In patients with complex EA/TEF, those who received postoperative acid suppression had a lower incidence of stricture. While it is reasonable to reduce the use of acid suppression after simple EA/TEF repair, infants with complex EA/TEF should receive acid suppression to reduce the risk of stricture.