ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula

Diagnostics, Preoperative, Operative, and Postoperative Management

Carmen Dingemann, Simon Eaton, Gunnar Aksnes, Pietro Bagolan, Kate M Cross, Paolo Decoppi, JoAnne Fruithof, Piergiorgio Gamba, Steffen Husby, Antti Koivusalo, Lars Rasmussen, Rony Sfeir, Graham Slater, Jan F Svensson, David C Van der Zee, Lucas M Wessel, Anke Widenmann-Grolig, Rene Wijnen, Benno M Ure

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Abstract

INTRODUCTION:  Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature.

MATERIALS AND METHODS:  Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9.

RESULTS:  Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1-9). Eight of these (62%) did not reach consensus.

CONCLUSION:  Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

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Consensus
Expert Testimony
Esophageal atresia with or without tracheoesophageal fistula
Internet
Guidelines
Pediatrics

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Dingemann, Carmen ; Eaton, Simon ; Aksnes, Gunnar ; Bagolan, Pietro ; Cross, Kate M ; Decoppi, Paolo ; Fruithof, JoAnne ; Gamba, Piergiorgio ; Husby, Steffen ; Koivusalo, Antti ; Rasmussen, Lars ; Sfeir, Rony ; Slater, Graham ; Svensson, Jan F ; Van der Zee, David C ; Wessel, Lucas M ; Widenmann-Grolig, Anke ; Wijnen, Rene ; Ure, Benno M. / ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula : Diagnostics, Preoperative, Operative, and Postoperative Management. In: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. 2019.
@article{16428704509e4ff6b59061c70f31f4c8,
title = "ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management",
abstract = "INTRODUCTION:  Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature.MATERIALS AND METHODS:  Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75{\%} of the votes scored 6 to 9.RESULTS:  Fifty-two items were generated with 116 relevant articles of which five studies (4.3{\%}) were assigned as level-1evidence. Complete consensus (100{\%}) was achieved on 20 items (38{\%}), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75{\%} was achieved on 37 items (71{\%}), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25{\%}) were controversial (range of scores, 1-9). Eight of these (62{\%}) did not reach consensus.CONCLUSION:  Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.",
author = "Carmen Dingemann and Simon Eaton and Gunnar Aksnes and Pietro Bagolan and Cross, {Kate M} and Paolo Decoppi and JoAnne Fruithof and Piergiorgio Gamba and Steffen Husby and Antti Koivusalo and Lars Rasmussen and Rony Sfeir and Graham Slater and Svensson, {Jan F} and {Van der Zee}, {David C} and Wessel, {Lucas M} and Anke Widenmann-Grolig and Rene Wijnen and Ure, {Benno M}",
note = "Georg Thieme Verlag KG Stuttgart · New York.",
year = "2019",
month = "7",
day = "2",
doi = "10.1055/s-0039-1693116",
language = "English",
journal = "European Journal of Pediatric Surgery",
issn = "0939-7248",
publisher = "GeorgThieme Verlag",

}

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula : Diagnostics, Preoperative, Operative, and Postoperative Management. / Dingemann, Carmen; Eaton, Simon; Aksnes, Gunnar; Bagolan, Pietro; Cross, Kate M; Decoppi, Paolo; Fruithof, JoAnne; Gamba, Piergiorgio; Husby, Steffen; Koivusalo, Antti; Rasmussen, Lars; Sfeir, Rony; Slater, Graham; Svensson, Jan F; Van der Zee, David C; Wessel, Lucas M; Widenmann-Grolig, Anke; Wijnen, Rene; Ure, Benno M.

In: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie, 02.07.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula

T2 - Diagnostics, Preoperative, Operative, and Postoperative Management

AU - Dingemann, Carmen

AU - Eaton, Simon

AU - Aksnes, Gunnar

AU - Bagolan, Pietro

AU - Cross, Kate M

AU - Decoppi, Paolo

AU - Fruithof, JoAnne

AU - Gamba, Piergiorgio

AU - Husby, Steffen

AU - Koivusalo, Antti

AU - Rasmussen, Lars

AU - Sfeir, Rony

AU - Slater, Graham

AU - Svensson, Jan F

AU - Van der Zee, David C

AU - Wessel, Lucas M

AU - Widenmann-Grolig, Anke

AU - Wijnen, Rene

AU - Ure, Benno M

N1 - Georg Thieme Verlag KG Stuttgart · New York.

PY - 2019/7/2

Y1 - 2019/7/2

N2 - INTRODUCTION:  Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature.MATERIALS AND METHODS:  Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9.RESULTS:  Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1-9). Eight of these (62%) did not reach consensus.CONCLUSION:  Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

AB - INTRODUCTION:  Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature.MATERIALS AND METHODS:  Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9.RESULTS:  Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1-9). Eight of these (62%) did not reach consensus.CONCLUSION:  Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

U2 - 10.1055/s-0039-1693116

DO - 10.1055/s-0039-1693116

M3 - Journal article

JO - European Journal of Pediatric Surgery

JF - European Journal of Pediatric Surgery

SN - 0939-7248

ER -