Evolving surgical practices in esophageal atresia: insights from the EUPSA-ERNICA survey a decade after the 2014 baseline
Evolving surgical practices in esophageal atresia: insights from the EUPSA-ERNICA survey a decade after the 2014 baseline
Objective: the European Paediatric Surgeons' Association (EUPSA) and the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) conducted a survey to assess the current surgical management and care practices for esophageal atresia (EA) in order to assess changes over the past decade.
Methods: an online survey consisting of 56 questions was administered to EUPSA members and ERNICA representatives between March and September 2025. The questionnaire covered seven domains: center structure, preoperative assessment, surgical management of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients and long-gap EA, postoperative care, long-term follow-up, and the management of complications. Results were compared to practices reported in a previous EUPSA Network Office survey in 2013.
Results: there were a total of 202 respondents from 41 countries with 60% from European Union countries. Compared with previous surveys, the routine use of preoperative bronchoscopy and the use of trans-anastomotic tubes were found to be significantly more common (both p < 0.001). A marked increase in preference for thoracoscopic techniques for EA-TEF was observed (p < 0.001). The routine use of chest drains, elective paralysis, and contrast studies prior to feeding initiation also rose significantly over the decade (p ≤ 0.004). Yet for many areas of care, there remains variation between surgeons, and structured long-term follow-up arrangements are not universal.
Conclusion: the findings demonstrate increased standardization and suggest increased adherence to recommendations in the management of EA-TEF. However, significant variation persists in long-term follow-up, transition-to-adult-care programs, and structured quality-of-life assessment, highlighting areas for future harmonization across European centers.
chest drain, esophageal atresia, patient care, survey, tracheoesophageal fistula
Soyer, Tutku
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Pederiva, Federica
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Pio, Luca
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Spivack, Olivia K.C.
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Sukhotnik, Igor
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Doktor, Fabian
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Zani-Ruttenstock, Elke
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Gorter, Ramon
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Dingemann, Jens
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Burgos, Carmen Mesas
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Wijnen, Rene
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Hall, Nigel
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5 February 2026
Soyer, Tutku
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Pederiva, Federica
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Pio, Luca
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Spivack, Olivia K.C.
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Sukhotnik, Igor
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Doktor, Fabian
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Zani-Ruttenstock, Elke
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Gorter, Ramon
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Dingemann, Jens
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Burgos, Carmen Mesas
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Wijnen, Rene
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Hall, Nigel
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Soyer, Tutku, Pederiva, Federica, Pio, Luca, Spivack, Olivia K.C., Sukhotnik, Igor, Doktor, Fabian, Zani-Ruttenstock, Elke, Gorter, Ramon, Dingemann, Jens, Burgos, Carmen Mesas, Wijnen, Rene and Hall, Nigel
(2026)
Evolving surgical practices in esophageal atresia: insights from the EUPSA-ERNICA survey a decade after the 2014 baseline.
European Journal of Pediatric Surgery, [EJPS-2026-01-7529-OA].
(doi:10.1055/a-2793-1101).
Abstract
Objective: the European Paediatric Surgeons' Association (EUPSA) and the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) conducted a survey to assess the current surgical management and care practices for esophageal atresia (EA) in order to assess changes over the past decade.
Methods: an online survey consisting of 56 questions was administered to EUPSA members and ERNICA representatives between March and September 2025. The questionnaire covered seven domains: center structure, preoperative assessment, surgical management of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients and long-gap EA, postoperative care, long-term follow-up, and the management of complications. Results were compared to practices reported in a previous EUPSA Network Office survey in 2013.
Results: there were a total of 202 respondents from 41 countries with 60% from European Union countries. Compared with previous surveys, the routine use of preoperative bronchoscopy and the use of trans-anastomotic tubes were found to be significantly more common (both p < 0.001). A marked increase in preference for thoracoscopic techniques for EA-TEF was observed (p < 0.001). The routine use of chest drains, elective paralysis, and contrast studies prior to feeding initiation also rose significantly over the decade (p ≤ 0.004). Yet for many areas of care, there remains variation between surgeons, and structured long-term follow-up arrangements are not universal.
Conclusion: the findings demonstrate increased standardization and suggest increased adherence to recommendations in the management of EA-TEF. However, significant variation persists in long-term follow-up, transition-to-adult-care programs, and structured quality-of-life assessment, highlighting areas for future harmonization across European centers.
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TITLE-EA survey-revised -28.11.2025
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Table 1-EA SURVEY_rev_ML
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Table 2-EA survey_rev_ML
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Table 3-Ea survey. 02.11.2025_rev_ML
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More information
Accepted/In Press date: 20 January 2026
e-pub ahead of print date: 23 January 2026
Published date: 5 February 2026
Keywords:
chest drain, esophageal atresia, patient care, survey, tracheoesophageal fistula
Identifiers
Local EPrints ID: 510821
URI: http://eprints.soton.ac.uk/id/eprint/510821
ISSN: 0939-7248
PURE UUID: c29cce23-71fb-4864-8094-9d896006bd56
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Date deposited: 22 Apr 2026 16:49
Last modified: 23 Apr 2026 01:49
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Contributors
Author:
Tutku Soyer
Author:
Federica Pederiva
Author:
Luca Pio
Author:
Olivia K.C. Spivack
Author:
Igor Sukhotnik
Author:
Fabian Doktor
Author:
Elke Zani-Ruttenstock
Author:
Ramon Gorter
Author:
Jens Dingemann
Author:
Carmen Mesas Burgos
Author:
Rene Wijnen
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