Skip to main content
SpringerLink
Log in

Radiographic assessment of traction-induced esophageal growth and traction-related complications of the Foker process for treatment of long-gap esophageal atresia

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Radiographic assessment of esophageal growth in long-gap esophageal atresia while on traction and associated traction-related complications have not been described.

Objective

To demonstrate how chest radiography can estimate esophageal position while on traction and to evaluate radiography’s utility in diagnosing certain traction system complications.

Materials and methods

In this retrospective evaluation of portable chest radiographs obtained in infants with long-gap esophageal atresia who underwent the Foker process between 2014 and 2020, we assessed distances between the opposing trailing clips (esophageal gap) and the leading and trailing clips for each esophageal segment on serial radiographs. Growth during traction was estimated using longitudinal random-effects regression analysis to account for multiple chest radiograph measurements from the same child.

Results

Forty-three infants (25 male) had a median esophageal gap of 4.5 cm. Median traction time was 14 days. Median daily radiographic esophageal growth rate for both segments was 2.2 mm and median cumulative growth was 23.6 mm. Traction-related complications occurred in 13 (30%) children with median time of 8 days from traction initiation. Daily change >12% in leading-to trailing clip distance demonstrated 86% sensitivity and 92% specificity for indicating traction-related complications (area under the curve [AUC] 0.853). Cumulative change >30% in leading- to trailing-clip distance during traction was 85% sensitive and 85% specific for indicating traction complications (AUC 0.874).

Conclusion

Portable chest radiograph measurements can serve as a quantitative surrogate for esophageal segment position in long-gap esophageal atresia. An increase of >12% between two sequential chest radiographs or >30% increase over the traction period in leading- to trailing-clip distance is highly associated with traction system complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Nassar N, Leoncini E, Amar E et al (2012) Prevalence of esophageal atresia among 18 international birth defects surveillance programs. Birth Defects Res 94:893–899

    Article  CAS  Google Scholar 

  2. Shieh HF, Jennings RW (2017) Long-gap esophageal atresia. Semin Pediatr Surg 26:72–77

    Article  Google Scholar 

  3. Fullington NM, Potanos KM, Cauley RP et al (2016) Strain induced esophageal growth in a novel rodent model. J Pediatr Surg 51:1273–1278

    Article  Google Scholar 

  4. Inoue S, Kosaka T, Takatsuki M et al (2015) Histological study of the elongated esophagus in a rat model. J Surg Res 195:495–501

    Article  Google Scholar 

  5. Lopes MF, Catré D, Cabrita A et al (2008) Effect of traction sutures in the distal esophagus of the rat: a model for esophageal elongation by Foker’s method. Dis Esophagus 21:570–573

    Article  CAS  Google Scholar 

  6. Foker J, Linden BC, Boyle EM, Marquardt C (1997) True primary repair for the full spectrum of esophageal atresia. Ann Surg 226:533–543

    Article  CAS  Google Scholar 

  7. Bairdain S, Hamilton TE, Smithers CJ et al (2015) Foker process for the correction of long gap esophageal atresia: primary treatment versus secondary treatment after prior esophageal surgery. J Pediatr Surg 50:933–937

    Article  Google Scholar 

  8. Svetanoff WJ, Zendejas B, Hernandez K et al (2021) Contemporary outcomes of the Foker process and evolution of treatment algorithms for long-gap esophageal atresia. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2021.02.054

  9. Liszewski MC, Bairdain S, Buonomo C et al (2014) Imaging of long gap esophageal atresia and the Foker process: expected findings and complications. Pediatr Radiol 44:467–475

    Article  Google Scholar 

  10. Vittinghoff E, Glidden D, Shiboski S, McCulloch C (2012) Regression methods in biostatistics: linear, logistic, survival, and repeated measures models, 2nd edn. Springer, New York

    Book  Google Scholar 

  11. Hanley J, McNeil B (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

    Article  CAS  Google Scholar 

  12. Shrout P, Fleiss J (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 98:420–428

    Article  Google Scholar 

  13. Baird R, Lal DR, Ricca RL et al (2019) Management of long gap esophageal atresia: a systematic review and evidence-based guidelines from the APSA outcomes and evidence based practice committee. J Pediatr Surg 54:675–687

    Article  Google Scholar 

Download references

Acknowledgments

Dr. Alexandra M. Foust and Dr. Benjamin Zendejas contributed equally to this manuscript. Dr. Thomas E. Hamilton and Dr. Michael J. Callahan contributed equally as senior authors to this manuscript.

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Alexandra M. Foust

  2. Department of Surgery, Boston Children’s Hospital, Boston, MA, USA

    Benjamin Zendejas, Somala Mohammed, Jay Meisner, David Zurakowski, Steven J. Staffa, Russell W. Jennings & Thomas E. Hamilton

  3. Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA

    David Zurakowski & Steven J. Staffa

  4. Department of Radiology, Boston Children’s Hospital, Boston, MA, 02115, USA

    Michael J. Callahan

Authors
  1. Alexandra M. Foust
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Zendejas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Somala Mohammed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jay Meisner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Zurakowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven J. Staffa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Russell W. Jennings
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas E. Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael J. Callahan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandra M. Foust.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Foust, A.M., Zendejas, B., Mohammed, S. et al. Radiographic assessment of traction-induced esophageal growth and traction-related complications of the Foker process for treatment of long-gap esophageal atresia. Pediatr Radiol 52, 468–476 (2022). https://doi.org/10.1007/s00247-021-05228-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-021-05228-z

Keywords

Search

Navigation