AUTHOR=Zarfati Angelo , Tambucci Renato , Bagolan Pietro , Conforti Andrea 

TITLE=Isoperistaltic gastric tube for long gap esophageal atresia (LGEA) in newborn, infants, and toddlers: a case-control study from a tertiary center

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1194928

DOI=10.3389/fped.2023.1194928

ISSN=2296-2360

ABSTRACT=BACKGROUND: limited evidence exists about outcomes after gastric tube formation as a last chance 
technique to avoid esophageal replacement in long gap esophageal atresia (LGEA). The last ERNICA 
Consensus Conference on the Management of LGEA has defined this among the priorities for future 
research. 
AIMS: analyze our experience with Isoperistaltic Gastric Tube (IGT) and compare its outcomes with
other techniques.
METHODS: a case-control study has been conducted. A retrospective monocentric analysis of LGEA 
patients (period: 2010-19) has been undertaken. Five IGT patients have been identified and each of 
these has been type matched with two cases of LGEA treated with other techniques. The follow-up 
(FU) considered was 24-months. 
RESULTS: IGT and controls showed no statistically significant differences regarding preoperative 
variables like sex, gestational age, birth weight, syndromes, and EA type. However, IGT patients had 
a significantly longer esophageal GAP (4.5 vertebral bodies vs 3.6, p=0.019) at time of surgery. The 
analysis showed no statistical difference among the two groups about operative outcomes, ICU or 
overall postoperative stay. No differences emerged between IGT and controls during the follow-up 
for GERD, esophagitis, fundoplication, dysphagia, vocal cord paralysis, stenosis and dilatations, 
auxologic data, need for revision, oral aversion, and death.
CONCLUSIONS: Isoperistaltic Gastric Tube was safe and effective even in LGEA patients with 
longer gaps, with good perioperative, post-operative and middle-term outcomes. This procedure may 
be considered as a possible alternative to avoid an esophageal substitution when a primary 
anastomosis seems impossible for a residual gap.