The Esophageal Anastomotic Stricture Index (EASI) for the management of esophageal atresia

Background: Anastomotic stricture is the most common complication following repair of esophageal atresia. An Esophageal Anastomotic Stricture Index (EASI) based on the postoperative esophagram may identify patients at high risk of stricture formation. Methods: Digital images of early postoperative esophagrams of patients undergoing EA repair from2005 to 2013 were assessed. Demographics and outcomes including dilations were prospectively collected. Upper (U-EASI) and lower (L-EASI) pouch ratios were generated using stricture diameter divided by maximal respective pouch diameter. Score performances were evaluated with area under the receiver operator curves (AUC) and the Fisher's exact test for single and multiple (N3) dilatations. Interrater agreement was evaluated using the intraclass correlation coefficient (ICC). Results: Forty-five patients had esophagrams analyzed; 28 (62%) required dilatation and 19 received N3 (42%). U-EASI and L-EASI ratios ranged from 0.17 to 0.70, with L-EASI outperforming the U-EASI as follows: L-EASI AUC: 0.66 for a single dilatation, 0.65 for N3 dilatations; U-EASI AUC: 0.56 for a single dilatation, 0.67 for N3 dilatations. All patients with an L-EASI ratio of ≥0.30 (n = 8) required multiple esophageal dilatations, p = 0.0006. The interrater ICC was 0.87. Conclusion: The EASI is a simple, reproducible tool to predict the development and severity of anastomotic stricture after esophageal atresia repair and can direct postoperative surveillance.