AAP 2026: Endoscopy Utilization and Disease Progression in Adult Survivors of Esophageal Atresia

Presenter: Alyssa Joachim, MD

Adults with a history of esophageal atresia/tracheoesophageal fistula (EA/TEF) may develop esophageal pathology, but the pace of progression and optimal surveillance intervals remain uncertain.

This retrospective cohort study used the Epic Cosmos database to examine disease transitions among 33,335 adults with EA/TEF, with a mean follow-up of 11.8 years (interquartile range [IQR] 7.6–14.6 years) and mean age at first visit of 58 years (IQR 44–69 years). During the study period, 50% (n=16,525) underwent adult endoscopy, with a mean interval of 1.89 years (IQR 0.85–3.44 years) between procedures. Among patients with a normal baseline endoscopy, esophagitis developed in 44.1% at 5 years and 72.0% at 10 years. Progression from esophagitis to Barrett’s esophagus without dysplasia occurred in 14.2% and 21.9%, respectively. Among those with Barrett’s esophagus without dysplasia, dysplasia developed in 22.8% at 5 years and 43.3% at 10 years, while progression to esophageal cancer occurred in 2.7% and 4.0%, respectively.

The observed progression over relatively short intervals suggests that the current 5–10-year surveillance interval may be insufficient for some adults with EA/TEF, warranting further evaluation of earlier and more frequent endoscopic surveillance.

American Academy of Pediatrics (AAP) National Conference & Exhibition 2026, October 2–6, San Diego, California