ESOPHAGEAL MUCOSAL METAPLASIA IN CHILDREN WITH ESOPHAGEAL ATRESIA

The potential for Barrett’s metaplasia with or without gastroesophageal reflux has been reported in the pediatric population and children with esophageal atresia (EA) may be at increased risk. Our group of EA patients with long-gap atresia is managed with esophageal traction and primary repair rather than gastric transposition and therefore at greater risk for reflux related problems. They examined endoscopic and histological findings in this group of patients.
Methods:

A retrospective review of endoscopic data in 34 children who had undergone upper endoscopy after esophageal atresia repair from 1997-2005. Only 3/34 had undergone repair without traction; a reflection of the referral population to our center. Endoscopic procedures were after Nissen fundoplication in the majority (30/34) and although 21/34 were either on a proton pump inhibitor or histamine antagonist these drugs were subsequently weaned.
Results:

The mean age of the group was 2.0 (1.4) years at the time of endoscopy. Abnormal esophageal mucosa characterized by irregularity of the z-line with an intestinal/gastric appearance was present 2 cm or greater above the lowest part of the esophagus in 12/34 (35%). In 6/34 (18%)it was well above 2cm and this latter group was older, mean age of 3.9 (2.9) years. In 3/34 (9%) cases the mucosa extended 4 cm or more. Histology of the abnormal mucosa was reported as cardiac mucosa in all cases without evidence of Barrett’s. Visible esophagitis was present in 10/34 (29%), predominantly grade 1, and 9/34 (26%) had histological evidence of esophagitis and 6/34 (18%) had both. Of these 2/6 had cardiac mucosa and none were on antacid treatment.
Conclusions:

There were no cases of Barrett’s metaplasia in children who had undergone traction to achieve primary repair however cardiac metaplasia was seen in a significant proportion. Although not entirely clear cardiac metaplasia may be a precursor Barrett’s and therefore long-term endoscopic follow-up is indicated in this group of patients.