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ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Surgery
Volume 12 - 2024 |
doi: 10.3389/fped.2024.1463165
The effectiveness and factors influencing frequency of endoscopic bougie dilatation in treating postoperative anastomotic stenosis of congenital esophageal atresia
Provisionally accepted
Xiao-qing He
Li-Jing Xiong
*
Xiao-Zhi Deng
*
Zheng-Bing Yang
*
Huan Yan
*
Yi-Xian Zhang
*
Li-hong Shang
*
Li-Rong Liu
*
Jing Li
*- Chengdu Women and Children’s Central Hospital, Chengdu, China
Abstract Objective This study is to evaluate the effectiveness and frequency factors of endoscopic bougie dilatation in treating postoperative anastomotic stenosis of congenital esophageal atresia (CEA). Methods The clinical data of patients of anastomotic stenosis with endoscopic bougie were retrospectively analyzed. According to the number of dilation times(ND), patients were divided into two groups (Group 0:ND < 3; Grooup1: ND≥3), and the differences in multiple clinical data were compared. Lasso regression and Ridge regression were used to screen important variables. Classification models were built utilizing various machine learning algorithms and their performance were evaluated. Finally, Kaplan-Meier model was used to estimate the probable-time distribution of children achieving normal feeding. Results Seventy-five patients underwent a total of 210 times of dilation, with a median of 3 times of dilation. The overall effectiveness was 98.67% (74/75), with perforation in 2 case (0.95%), and obvious bleeding in 3 cases (1.43%). Initial diameter of bougie, final diameter of bougie, treatment pattern (Regular: dilation each 4weeks; Wait-and-see: dilation until symptoms present), age at final dilation, esophageal obstruction by food were the factors related to ND. Random Forest (RF) and Logistic regression (LR) model were excellent models for predicting ND. The median age for achieving normal eating in Group0 was 120 days (95%CI: 90-160), while it was 270 days (95%CI:240-460) in Group1 with a statistically significant difference (P<0.0001). Conclusion Endoscopic bougie dilatation is a safe and effective treatment for anastomotic stenosis. Selecting the appropriate bougie, using symptoms as the criterion for dilation, and minimizing the dilations under 3 times constitute a rational strategy.
Keywords: Anastomotic stenosis, Congenital esophageal atresia, endoscopic bougie dilatation, machine learning models, random forest model, logistic regression model, nomogram
Received: 11 Jul 2024; Accepted: 15 Oct 2024.
Copyright: © 2024 He, Xiong, Deng, Yang, Yan, Zhang, Shang, Liu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Li-Jing Xiong, Chengdu Women and Children’s Central Hospital, Chengdu, China
Xiao-Zhi Deng, Chengdu Women and Children’s Central Hospital, Chengdu, China
Zheng-Bing Yang, Chengdu Women and Children’s Central Hospital, Chengdu, China
Huan Yan, Chengdu Women and Children’s Central Hospital, Chengdu, China
Yi-Xian Zhang, Chengdu Women and Children’s Central Hospital, Chengdu, China
Li-hong Shang, Chengdu Women and Children’s Central Hospital, Chengdu, China
Li-Rong Liu, Chengdu Women and Children’s Central Hospital, Chengdu, China
Jing Li, Chengdu Women and Children’s Central Hospital, Chengdu, China
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