O-06 (17:05 to 17:17): The Management of Postoperative Reflux in Congenital Esophageal Atresia- Tracheoesophageal Fistula: A Systematic Review

Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). GER may exacerbate anastomotic strictures or lead to serious respiratory sequelae. We performed a systematic review of the literature regarding the medical management of GER post EA-TEF repair. A comprehensive search was conducted of MEDLINE, EMBASE, CINHAL, CENTRAL, Cochrane Systematic Review Database and grey literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications. Screening of 2910 articles resulted in 25 included articles (N = 1663). Most were single center studies (92%) and the majority were retrospective (76%); there were no randomized control trials (RCT). Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1663 (26.0%) patients (23 papers). Average follow- up was 53.2 months (14 studies). The quality of literature regarding the medical management of GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary for the development of guidelines to decrease postoperative GER in EA-TEF patients