Anastomotic Stricture Definition After Esophageal Atresia Repair: Role of Endoscopic Stricture Index

Background: To evaluate the feasibility and efficacy of endoscopic stricture index (SIEN) to define anastomotic strictures (ASs) and to predict the need of dilatations. Materials and methods: A retrospective longitudinal study was conducted on patients who underwent esophageal atresia repair from 1998-2020 (ethical committee approval CHPED- 05-20-AS). SIEN was calculated on the first endoscopy performed as follows: (D d )/D, where D is the maximum diameter of lumen of the upper esophagus close to the AS and d is the diameter of lumen of the stricture. Nonparametric variables were examined using Wilcoxon-Mann-Whitney test, and continuous variables were analyzed using Spearman’s test and regression analysis. A P value <0.05 was considered statistically significant. The sensitivity, specificity, and positive and negative predictive values of SIEN were also calculated, and a receiver operating characteristic curve was designed. Results: A total of 46 patients were included in the study. A statistically significant corre- lation was found between SIEN and number of dilations (Spearman’s correlation rate, 0.7; P < 0.0005). A SIEN threshold value !0.6 showed sensitivity of 100%, specificity of 80%, positive predictive value of 54%, negative predictive value of 100%, and the area under the curve of 84%. Conclusions: SIEN seems to be a good AS definer and prognostic tool; our study suggests that an AS could be defined by a SIEN !0.6.