Thoracoscopic Repair of Esophageal Atresia by Ravi P Kanojia

Author:Ravi P Kanojia
Language: eng
Format: epub
ISBN: 9789819756957
Publisher: Springer Nature Singapore

Subjective Evaluation of Stricture on Esophagogram

Contrast esophagogram obtained after esophageal anastomosis is the standard practice. Its use and timing are variable with different centers. In the author’s practice timing of esophagograms will depend on leak risk probability. In patients who are classified as high-risk, i.e., with the anastomosis under tension and leak in the recovery period, there will be two esophagograms. The first esophagogram is done before the initiation of oral feeds after thoracoscopic repair; this is done once the leak is resolved. The authors have reported a quantitative index in the form of esophageal anastomotic caliber index (EACI) which correlates well with the risk of stricture formation. This is a ratio measured on X-ray images of esophagograms with diameters at, above, and below the level of anastomosis (Figs. 9.7 and 9.8). The average of D/DU and D/DL will be the EACI. If the EACI is 0.35, then this means that the anastomosis area is 35% of a normal esophagus diameter. If EACI [15] is adverse (below 0.65), the chances of stricture formation are high, and a second dye study is done after 8 weeks of discharge. If the EACI is favorable (>0.65), the dye study can be done after 3 months of discharge. If, on the second dye study, there is stricture, then serial endoscopic balloon dilatations are done for managing stricture.

Fig. 9.7Ratios and calculation used for estimating esophageal anastomotic caliber index

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