• Vol. 42 No. 6, 297–300
  • 15 June 2013

Clinical Outcomes of Esophageal Atresia: Comparison Between the Waterston and the Spitz Classifications



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Introduction: Preoperative prognostic predictors are important for surgeons and parents to estimate the survival of patients with esophageal atresia (EA). The aim of this study was to update the clinical outcomes of EA treatment by comparing between the Waterston and the Spitz classification.

Materials and Methods: Medical records of the patients with EA treated at Queen Sirikit National Institute of Child Heath from 2003 to 2010 were reviewed. All of the patients were categorised into 3 groups of the Waterston and 3 groups of the Spitz risk factor criteria for comparing of the differences in each group and each classification.

Results: One hundred and thirty-two patients (81 males and 61 females) were treated for EA during the study period. Applying the Waterston classification, survival rate was 100% in group A, 91.5% in group B and 48.8% in group C. There was no statistical difference between the survival rate in group A and group B (P = 0.119) but significant difference between group B and group C (P = 0.000). Using the Spitz classification, survival rate was 97.4% in group I, 64.4% in group II and 27.3% in group III. There was obviously statistical difference of the survival rate between each group (group I vs group II, P = 0.000; group II vs group III, P = 0.041).

Conclusion: Comparing with the prognostic predictors, the Spitz classification was more valid than the Waterston criteria. The Spitz classification is suitable to use for preoperative predictor to parental counselling and comparing of treatment outcomes of EA among paediatric tertiary care centres.

Esophageal atresia (EA) is the most common and seriousanomaly of the esophagus. The abnormality was uniformly fatal throughout the world prior to 1939. The first survivors of
esophageal repair were reported by Leven1 and Ladd. Later on, the survival rate of the disease continuously improved to more than 90% in this era.3-5 The good results of esophageal treatment reflect the advances in neonatal intensive care, nutritional support, improvement of anesthetic and surgical techniques.

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