Anastomotic stenosis after surgical repair of esophageal atresia: A systematic review and meta-analysis of 6,968 patients

Abstract

Background: The prevalence of anastomotic stenosis (AS) following surgical repair of esophageal atresia (EA) remains uncertain and is a debatable issue among pediatric surgeons. The present systematic review aimed to determine the real prevalence of AS (global and by subgroups). Methods: We performed a systematic review (PROSPERO: ID CRD420251001335), according to the PRISMA protocol. Two investigators independently search on MEDLINE/Pubmed, Cochrane Library, Scopus and Web of Science data bases. Studies in English language published between 1st January 2019 and 31st December 2024 that documented the number of AS cases were included. Systematic and narrative review articles, case reports, letters, protocols/guidelines were excluded. We also excluded studies with: repeated pools; no clear relationship between AS and esophageal replacement; refractory or congenital AS. NHLBI study quality assessment tools were used for internal validity evaluation. Meta-analysis was performed using r packages: metafor and meta, and subgroup analysis were performed. Results: From the 693 retrieved publications, 42 full-text articles were included, the latter encompassing 2,362 AS out of 6,968 patients with known anastomotic status. The AS prevalence was 39.7% (95% CI: 33.6% to 45.8%; I2=97%). Among the 30 subgroup analyses, only delayed/staged repair was related to a significant higher (55.9%) AS prevalence (95% CI: 46.8% to 65.1%; I2=16%). Conclusion: The prevalence of AS was high. We detected selection/reporting bias, and almost all studies revealed excessive heterogeneity. In order to find out high level evidence, after adoption of clear guidelines for screening and of an objective definition of AS, further comparative randomized controlled trials are needed.