A recent study of patients who had undergone repair of esophageal atresia (Koivusalo et al. JPGN 2016; 62: 562-66) confirms that “routine endoscopic surveillance had limited benefit and seems unnecessary” before 15 years of age.
A retrospective review of pediatric patients with esophageal atresia (EA) from 1980-2014) identified 209 patients with 616 biopsies. 60 patients had undergone antireflux surgery. Key findings:
- Gr I esophagitis was noted in 37%, Gr II or III in 16%.
- Gastric metaplasia was found in 17% and reached a prevalence of 15% by age 15 years.
- Only 9% of patients with gastric metaplasia and 32% of patients with gr II esophagitis were symptomatic.
- No cases of dysplasia or cancer were identified.
My take: Conditions, including esophageal atresia, that predisposed to chronic reflux esophagitis increase the risk of esophageal malignancy; however, this risk remains very low in childhood. Therefore, surveillance for asymptomatic children is not needed prior to age 15 years.
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