Eosinophilic esophagitis after tracheoesophageal fistula repair

Purpose Eosinophilic esophagitis (EOE) is a known complication in children with esophageal atresia (EA) and tracheoesophageal fistula (TEF) following repair. Knowledge of EOE prevalence and characteristics among children following EA/TEF repair is limited. This study evaluates the prevalence, time to diagnosis, and clinical characteristics associated with EOE after EA/TEF repair. Methods We identified a retrospective cohort of primary EA/TEF patients who underwent repair from Jan 1, 2017, to Nov 1, 2023 at a single institution. Long-term follow-up was obtained through our Esophageal and Airway Clinic (EAC) and chart review. EOE diagnosis was defined as >15 eosinophils per high-power field on endoscopic-directed biopsy. Results Sixty-six primary EA/TEF patients who underwent repair and who also had a 1-year EGD with biopsy were included. A diagnosis of EOE was confirmed in 13 patients (19.7 %) with a mean time to diagnosis of 22 months. Postoperative outcomes after repair were largely similar across the EOE and non-EOE cohorts. 73 % (48/66) of patients underwent at least one stricture dilation postoperatively. EOE patients received significantly more dilations than non-EOE patients (median 7 vs. 2, p=0.005). Kaplan–Meier analysis demonstrated a trend toward significantly earlier dilation among patients with EOE compared with non-EOE patients (log-rank χ 2 (1) = 3.82, p=0.05). Conclusion In this large cohort of postoperative primary EA/TEF patients we found a high rate of EOE. EOE patients required earlier and more frequent stricture dilations. Our results exemplify the still-undefined physiologic interplay between the underlying pathophysiology of the esophagus after EA/TEF repair and development of EOE. Level of Evidence III (retrospective cohort study).