Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee

Robert Baird, Dave R. Lal, Robert L. Ricca, Karen A. Diefenbach, Cynthia D. Downard, Julia Shelton, Stig Sømme, Julia Grabowski, Tolulope A. Oyetunji, Regan F. Williams, Tim Jancelewicz, Roshni Dasgupta, L. Grier Arthur, Akemi L. Kawaguchi, Yigit S. Guner, Ankush Gosain, Robert L. Gates, Juan E Sola, Lorraine I. Kelley-Quon, Shawn D. St. PeterAdam Goldin

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Background: Treatment of the neonate with long gap esophageal atresia (LGEA) is one of the most challenging scenarios facing pediatric surgeons today. Contributing to this challenge is the variability in case definition, multiple approaches to management, and heterogeneity of the reported outcomes. This necessitates a clear summary of existing evidence and delineation of treatment controversies. Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee drafted four consensus-based questions regarding LGEA. These questions concerned the definition and determination of LGEA, the optimal method of surgical management, expected long-term outcomes, and novel therapeutic techniques. A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to identify, review and report salient articles. Results: More than 3000 publications were reviewed, with 178 influencing final recommendations. In total, 18 recommendations are provided, primarily based on level 4–5 evidence. These recommendations provide detailed descriptions of the definition of LGEA, treatment techniques, outcomes and future directions of research. Conclusions: Evidence supporting best practices for LGEA is currently low quality. This review provides best recommendations based on a critical evaluation of the available literature. Based on the lack of strong evidence, prospective and comparative research is clearly needed. Type of study: Treatment study, prognosis study and study of diagnostic test. Level of evidence: Level II–V.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Esophageal Atresia
Evidence-Based Practice
Guidelines
Pediatrics
Therapeutics
Practice Guidelines
Research
Routine Diagnostic Tests
Publications
Meta-Analysis
Newborn Infant

Keywords

  • Esophageal atresia
  • Esophageal substitution
  • Long gap esophageal atresia

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Management of long gap esophageal atresia : A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee. / Baird, Robert; Lal, Dave R.; Ricca, Robert L.; Diefenbach, Karen A.; Downard, Cynthia D.; Shelton, Julia; Sømme, Stig; Grabowski, Julia; Oyetunji, Tolulope A.; Williams, Regan F.; Jancelewicz, Tim; Dasgupta, Roshni; Arthur, L. Grier; Kawaguchi, Akemi L.; Guner, Yigit S.; Gosain, Ankush; Gates, Robert L.; Sola, Juan E; Kelley-Quon, Lorraine I.; St. Peter, Shawn D.; Goldin, Adam.

In: Journal of Pediatric Surgery, 01.01.2019.

Research output: Contribution to journalReview article

Baird, R, Lal, DR, Ricca, RL, Diefenbach, KA, Downard, CD, Shelton, J, Sømme, S, Grabowski, J, Oyetunji, TA, Williams, RF, Jancelewicz, T, Dasgupta, R, Arthur, LG, Kawaguchi, AL, Guner, YS, Gosain, A, Gates, RL, Sola, JE, Kelley-Quon, LI, St. Peter, SD & Goldin, A 2019, 'Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2018.12.019
Baird, Robert ; Lal, Dave R. ; Ricca, Robert L. ; Diefenbach, Karen A. ; Downard, Cynthia D. ; Shelton, Julia ; Sømme, Stig ; Grabowski, Julia ; Oyetunji, Tolulope A. ; Williams, Regan F. ; Jancelewicz, Tim ; Dasgupta, Roshni ; Arthur, L. Grier ; Kawaguchi, Akemi L. ; Guner, Yigit S. ; Gosain, Ankush ; Gates, Robert L. ; Sola, Juan E ; Kelley-Quon, Lorraine I. ; St. Peter, Shawn D. ; Goldin, Adam. / Management of long gap esophageal atresia : A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee. In: Journal of Pediatric Surgery. 2019.
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title = "Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee",
abstract = "Background: Treatment of the neonate with long gap esophageal atresia (LGEA) is one of the most challenging scenarios facing pediatric surgeons today. Contributing to this challenge is the variability in case definition, multiple approaches to management, and heterogeneity of the reported outcomes. This necessitates a clear summary of existing evidence and delineation of treatment controversies. Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee drafted four consensus-based questions regarding LGEA. These questions concerned the definition and determination of LGEA, the optimal method of surgical management, expected long-term outcomes, and novel therapeutic techniques. A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to identify, review and report salient articles. Results: More than 3000 publications were reviewed, with 178 influencing final recommendations. In total, 18 recommendations are provided, primarily based on level 4–5 evidence. These recommendations provide detailed descriptions of the definition of LGEA, treatment techniques, outcomes and future directions of research. Conclusions: Evidence supporting best practices for LGEA is currently low quality. This review provides best recommendations based on a critical evaluation of the available literature. Based on the lack of strong evidence, prospective and comparative research is clearly needed. Type of study: Treatment study, prognosis study and study of diagnostic test. Level of evidence: Level II–V.",
keywords = "Esophageal atresia, Esophageal substitution, Long gap esophageal atresia",
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T2 - A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee

AU - Baird, Robert

AU - Lal, Dave R.

AU - Ricca, Robert L.

AU - Diefenbach, Karen A.

AU - Downard, Cynthia D.

AU - Shelton, Julia

AU - Sømme, Stig

AU - Grabowski, Julia

AU - Oyetunji, Tolulope A.

AU - Williams, Regan F.

AU - Jancelewicz, Tim

AU - Dasgupta, Roshni

AU - Arthur, L. Grier

AU - Kawaguchi, Akemi L.

AU - Guner, Yigit S.

AU - Gosain, Ankush

AU - Gates, Robert L.

AU - Sola, Juan E

AU - Kelley-Quon, Lorraine I.

AU - St. Peter, Shawn D.

AU - Goldin, Adam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Treatment of the neonate with long gap esophageal atresia (LGEA) is one of the most challenging scenarios facing pediatric surgeons today. Contributing to this challenge is the variability in case definition, multiple approaches to management, and heterogeneity of the reported outcomes. This necessitates a clear summary of existing evidence and delineation of treatment controversies. Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee drafted four consensus-based questions regarding LGEA. These questions concerned the definition and determination of LGEA, the optimal method of surgical management, expected long-term outcomes, and novel therapeutic techniques. A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to identify, review and report salient articles. Results: More than 3000 publications were reviewed, with 178 influencing final recommendations. In total, 18 recommendations are provided, primarily based on level 4–5 evidence. These recommendations provide detailed descriptions of the definition of LGEA, treatment techniques, outcomes and future directions of research. Conclusions: Evidence supporting best practices for LGEA is currently low quality. This review provides best recommendations based on a critical evaluation of the available literature. Based on the lack of strong evidence, prospective and comparative research is clearly needed. Type of study: Treatment study, prognosis study and study of diagnostic test. Level of evidence: Level II–V.

AB - Background: Treatment of the neonate with long gap esophageal atresia (LGEA) is one of the most challenging scenarios facing pediatric surgeons today. Contributing to this challenge is the variability in case definition, multiple approaches to management, and heterogeneity of the reported outcomes. This necessitates a clear summary of existing evidence and delineation of treatment controversies. Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee drafted four consensus-based questions regarding LGEA. These questions concerned the definition and determination of LGEA, the optimal method of surgical management, expected long-term outcomes, and novel therapeutic techniques. A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to identify, review and report salient articles. Results: More than 3000 publications were reviewed, with 178 influencing final recommendations. In total, 18 recommendations are provided, primarily based on level 4–5 evidence. These recommendations provide detailed descriptions of the definition of LGEA, treatment techniques, outcomes and future directions of research. Conclusions: Evidence supporting best practices for LGEA is currently low quality. This review provides best recommendations based on a critical evaluation of the available literature. Based on the lack of strong evidence, prospective and comparative research is clearly needed. Type of study: Treatment study, prognosis study and study of diagnostic test. Level of evidence: Level II–V.

KW - Esophageal atresia

KW - Esophageal substitution

KW - Long gap esophageal atresia

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