Use of trans-anastomotic tubes in congenital duodenal obstruction.

AIM: Despite data to suggest benefit of trans- anastomotic tube (TAT) feeding in infants following repair of congenital duodenal obstruction (CDO), TAT usage is limited. We aimed to report a large series of infants with CDO treated with or without TAT in order to improve the evidence underlying this simple intervention. METHOD: Single centre retrospective review of all infants CDO over a 20-year period (January 1999 - November 2020, inclusive). Important outcomes were compared between infants treated with or without TAT. Data are median [IQR]. RESULTS: Ninety-six infants were included. A TAT was placed in 54 infants (56%). Median time to full enteral feed was significantly shorter in the TAT group (6 [5-8] days vs 10 [7.5-12], p <0.001). Time to first feed was shorter in the TAT group (2 [2-2.8] days vs 3 [2-5], p<0.001). Significantly fewer infants with a TAT placed received a central venous catheter (CVC, 15% vs 76%, p <0.001). Infants without a TAT received parenteral nutrition (PN) for longer (0 [0-0] vs 7 [0-11] days, p <0.001). There was no change in length of stay between TAT and no TAT group (16 [13-21.8] vs 15 [12-21.8] days, p = 0.722). Eight infants (15%) in the TAT group required a CVC and PN. One infant in the TAT group developed a perforation that required surgical management and nine infants in the non-TAT group had complications related to the CVC (21%), including one infant that required general anaesthetic for tunnelled central line placement (2.3%). CONCLUSION: In infants with CDO, TAT use was associated with earlier establishment of full enteral feeds, reduced need for CVC and PN and reduced complications. Further research should focus on the barriers to wider use of TAT by surgeons and neonatologists in infants with CDO.

Fluoroscopic balloon dilatation for anastomotic strictures in patients with esophageal atresia: A fifteen-year single centre UK experience.

AIM OF THE STUDY: To assess the safety and effectiveness of fluoroscopic balloon dilatation (FBD) in children with esophageal anastomotic stricture after surgical repair of esophageal atresia. METHODS: All patients undergoing surgery for esophageal atresia and requiring dilatation(s) during a consecutive 15-year period [April 2000-September 2014] were analyzed. Dilatations were performed as day case procedures under general anesthesia using a radial force generating balloon device (Boston Scientific Corporation) by surgeons. Outcomes assessed included - (1) the number of dilatations/patient, (2) effectiveness and (3) need for surgery and (4) complications. RESULTS: One hundred thirty seven patients underwent 625 FBD sessions (median 3 dilations per patient; range 1-24 dilatations). Median age at 1st FBD was 0.74years (range 0.05-16.1years). Balloon catheter sizes ranged from 6mm to 20mm. FBD yielded excellent results in 99 patients (74%), while 17 cases (13%) had mild ongoing dysphagia/dysmotility. Ten patients (7%) required further dilatation(s) to control symptoms. No patient(s) required esophageal stenting. Five cases required G-tube feeds as a result of oral aversion behavior - all of these cases were complex/VACTERL patients. Only 1 minor radiological leak occurred after a dilatation session and this did not require surgical intervention. A single patient (long gap EA TEF) with severe neurological impairment having multiple dilatations and stricture resection ultimately required esophageal replacement. Anti-reflux surgery was performed in 36 patients (26%) for medical therapy resistant GER. CONCLUSION: FBD for anastomotic stricture(s) following esophageal atresia repair achieved very good outcomes for the majority of EA TEF patients. The procedure can be accomplished safely as indicated by the low complication rate herein reported. Although some children may require more than one dilatation session prompt relief of symptoms can be achieved with a vigilant care program co-ordinated by a multidisciplinary specialist EA TEF team.

Thoracic amyloidomas: Two case reports of an evasive diagnosis.

Amyloidosis is a rare differential diagnosis of a mass detected in the chest. Amyloidoma is caused by a local proliferation of clonal B-cells secreting an unstable immunoglobulin light chain which accumulates. FDG-PET scan are useful but not specific. Treatment is generally by local resection for treatment of symptoms. We report two cases of amyloidomas, which are rare entities characterised by large local amyloid deposits. These can occur in the upper respiratory tract, soft tissues and central nervous system.(1.)