OA09.7. Burden of Long-Term Morbidity After Oesophageal Atresia ± Tracheo-Oesophageal Fistula Repair: Systematic Review and Pooled Prevalence Synthesis

Abstract

Benign Disease: Pediatric Esophageal Disorders Survival after congenital oesophageal atresia (EA) with/without tracheo-oesophageal fistula (TEF) now exceeds 90%, shifting focus to long-term oesophageal morbidity. Reported rates of outcomes like reflux, strictures, dysphagia and mucosal change vary widely due to inconsistent definitions, surveillance intensity and follow-up stage (symptom/proxy vs physiology/endoscopy). We synthesised contemporary post-repair outcomes to support counselling and follow-up planning. PRISMA-guided systematic review. MEDLINE and Embase (Ovid) were searched (2000–2025; last search 21 Oct 2025) for primary studies reporting postnatal outcomes in congenital EA (any type) ± TEF (including H-type; excluding acquired fistulae). Study quality was appraised using the Newcastle–Ottawa Scale (independently, with consensus resolution). Given heterogeneity in definitions/denominators and follow-up windows, synthesis followed SWiM principles. Outcomes were classified as reported (k) and poolable (k*). For k* subsets, crude pooled prevalence (Σevents/ΣN) with Wilson 95% confidence intervals (CIs) was calculated as a cross-study summary (not heterogeneity-adjusted meta-analytic uncertainty). Exploratory contrasts used risk ratios (RRs) and risk differences derived from pooled subgroup totals and were interpreted as hypothesis-generating. Forty studies were included (n=8,717; median NOS 6/9). In poolable cohorts, mortality was 10.3% (743/7,217; 95% CI 9.6–11.0). GERD occurred in 39.2% (562/1,434; 36.7–41.7) and was higher in cohorts using physiology-based assessment than symptom/proxy definitions (60.0% vs 38.0%; RR 1.58, ≈95% CI 1.30–1.92). Fundoplication was 24.3% (220/907; 21.6–27.2); among cohorts reporting both, 35.4% of GERD cases underwent fundoplication. Anastomotic stricture/stenosis occurred in 34.8% (395/1,136; 32.1–37.6) and was similar when restricted to dilation-defined strictures (35.4%, 52/147; 28.1–43.4). Dysphagia was 41.2% (148/359; 36.3–46.4) and was higher with adolescent/adult follow-up (RR 3.05, ≈95% CI 2.33–3.98). Feeding difficulty was 83.8% (378/451; 80.1–86.9; limited poolable evidence) and airway morbidity 11.8% (70/593; 9.4–14.7). Metaplasia was 7.8% (79/1,011; 6.3–9.6) with higher prevalence in adult follow-up (20.8% vs 6.4%; RR 3.26, ≈95% CI 2.12–5.03). Recurrent TEF/major reoperation was 3.2% (132/4,146; 2.7–3.8). EA/TEF survivorship carries substantial long-term morbidity and intervention burden, particularly reflux, strictures and swallowing/feeding dysfunction, with measurable metaplasia in long-term cohorts. Wide between-study variation reflects inconsistent outcome definitions, surveillance strategies and non-comparable follow-up metrics (months vs age-at-assessment), limiting benchmarking and short- vs long-term classification. Findings support structured, life-course multidisciplinary follow-up and highlight the need for multicentre standardisation of core outcomes, denominators and life-stage follow-up windows, with surveillance intensity explicitly reported. Harmonised follow-up frameworks are required to enable meaningful benchmarking and future robust meta-analysis, and to guide consistent long-term care pathways.