Oesophageal atresia and associated anomalies: a plea for uniform documentation

Abstract

Although associated congenital anomalies are the most significant factor affecting prognosis in babies with oesophageal atresia (OA), there is considerable variation in the methods by which they have been documented. To facilitate a uniform approach to the reporting of associated anomalies, we have analysed the data from our own experience and studied the methods used by other workers. During the period 1948–1991, 618 patients with OA and/or tracheo-oesophageal fistula were admitted to the Royal Children's Hospital, Melbourne. Concurrent congenital abnormalities were present in 344 (56%), the most frequent being cardiovascular (20.7%); urinary (21.6%); gastrointestinal (22.7%); and orthopaedic (15.7%). Not only have reports of the incidence of associated anomalies in OA involved a wide variety of classifications, but also they have varied in the extent to which co-existent lesions were sought by investigation. These factors, in addition to the criteria used for inclusion and the method of their documentation, have resulted in marked discrepancies in the apparent incidence of specific anomalies, and made valid comparisons between series difficult or impossible. We advocate a simple approach whereby: (1) data should be collected prospectively; (2) routine investigation should include renal ultrasound and echocardiography (as a minimum requirement); (3) the number of associated anomalies should be reported as a percentage of the total cohort of patients, rather than as a percentage of the anomalies themselves; (4) true congenital anomalies should be recorded separately from acquired conditions; and (5) the wide variation in the impact of associated abnormalities on the management and long-term outlook in OA should be recognized.