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Forum Name: Gastroenterology Topics

Question: Regular endoscopy schedule for EA/TEF follow-up?


 MeghanOrange - Mon Jul 05, 2010 5:03 pm

Hi, 30 y/o female, EA/TEF repair at birth (and VATER assoc.). I have had minor GER, motility problems, hiccups, etc, related to this my entire life. I had barium films when I was a kid and recently just had a barium film that was 'normal' excluding the expected stricture at the surgical site and 'very mild, if there at all' pre-achalasia. About 10 years ago, I had an increase in GER and so I had an upper-endoscopy that came back 'normal' excluding mild erythema in lower third, and fibrosis at surgery site. This increase is resolved and now only occasional GER.

My question is, do you know of a recommended 'schedule' for someone with my medical history (EA/TEF) to get barium films or upper endoscopy follow-up? I would think the barium films should be minimized and only done when there are apparent symptoms that wouldn't show up with endoscopy (specific motility/reflux problems?) because of the radiation exposure. But as far as endoscopy, I don't think there are any significant risks to getting it done. Off the top of my head I was thinking maybe I should talk to my doctor about getting this done every 10-years or so? I wanted an opinion before I went in to talk about it and since I won't be seeing the doctor anytime soon. My concern is related to hearing that EA/TEF patients have a higher chance of developing esophageal cancers.

Oh, and I do have some additional problems with vomiting more than the average person (due to severe & chronic motion sickness) and I also have a history of heavy drinking (but zero alcohol now). These things don't help for sure, I know.

Thanks!
 Dr.M.Aroon kamath - Sat Jul 17, 2010 1:13 pm

User avatar Hi,
In patients with esophageal atresia(EA) and a tracheo-esophageal fistula (TEF), abnormal esophageal motility is always present because of abnormal development and innervation of esophagus. Long-term follow-up studies have reported complications of hiatal hernia, esophagitis, and Barrett esophagus.Hiatus hernia is perhaps the commonest (80%).

Gastroesophageal reflux disease may later occur in half of patients who had repair for esophageal atresia and TEFs during the neonatal period. Rare complications of reflux are Barrett esophagus and esophageal carcinoma.

Worldwide, a handful of cases(<10) of esophageal cancer have been reported in young adults treated in the past for EA (to the best of my knowledge).

The overall cancer incidence does not seem to differ from that of the general population.

You indicate that you suffer from "VACTERL association". This is a non-random association of birth defects that affects multiple organ systems.

The term VACTERL is an acronym.

(V): Vertebral abnormalities
(A): Anal atresia
(C): Cardiac (heart) defects
(T): Tracheal anomalies including tracheoesophageal fistula
(E): Esophageal atresia
(R): Renal (kidney) and radial abnormalities
(L): Limb abnormalities.

Vertebral malformations may include the entire spectrum of congenital spinal deformities, including kyphosis.

There is little doubt that safety, flexibility, and enhanced visibility, make flexible fibreoptic endoscopy, the preferred instrument for most diagnostic and therapeutic esophageal procedures.

You have not indicated if you have any vertebral anomaly.Some of these anomalies(if severe and located in the cervical or thoracic spine) may render endoscopy somewhat hazardous. You have mentioned that you had undergone an endoscopy 10 years ago.Obviously there had been no technical difficulty for endoscopy at that time.

Now that you are 28 years old(10 years later), there is a likelihood that the vertebral anomalies/deformities(if any) could have changed as well(for the better or for the worse).If worse and severe, they can render endoscopy hazardous. Also, esophageal strictures or food impaction(as in achalasia) may increase the risk of esophageal perforation during endoscopy/instrumentation.

Your doctor must have considered all these factors before opting for a barium study.It was most probably an individualized management decision for 'your' individual case, rather than a protocol- based decision.
Best wishes!
 MeghanOrange - Sat Jul 17, 2010 2:46 pm

Thank you Sir! That was quite helpful and I learned some new things from you.

Perhaps I could submit myself as a case study to show the dangers of EA/TEF repair when exacerbated by heavy drinking and excessive vomiting! :-)

Thanks again.
 Dr.M.Aroon kamath - Mon Jul 19, 2010 2:12 am

User avatar Hi MeghanOrange,
Thank you so much. It was my pleasure trying to answer your most intriguing post.
I wish you well.

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