Esophageal Atresia and Tracheoesophageal Fistula, is Waterston`s Classification Still Valid?

Aim: Due to advances in the operative techniques and neonatal care, the Waterston's system of prognostic classification for oesophageal atresia (EA) is no longer followed in the developed-world.

Objective: The aim of this study was to evaluate the validity of risk stratification according to the Waterston`s Classification system for the repair of EA/TEF in the developing-countries.

Methods: This is a retrospective study, in which all 30 cases of congenital EA/TEF admitted to Bolan Medical-College Hospital, Quetta from July 2013 to January 2018 were studied. Risk-stratification was done according to the Waterston’s classification system. Institutional review board of bolan medical college authorized the study.

Results: Among the 30 records reviewed in this study, 90% of the patients were born outside BMCH. The diagnosis was made postnatally by means of nasogastric tube and chest X-ray (83%). The most common type of TEF was Type C (98%). The most common post-operative complication was pneumonia (43%). Overall survival rate was 83%. Cardiac-anomalies were the major associated cause of mortality. All patients who died had major cardiac anomalies p -<0.05.

Risk stratification according to Waterston’s-classification system showed 100% survival in Groups A, 82% in Group B and 75 % in Group C.

Conclusion: We conclude that the risk stratification according to Waterston’s-classification, which is now being considered obsolete in the developed world, is still valid in the developing countries like Pakistan because it is a relevant prognostic indicator it helps in deciding the surgical intervention, and has better correlation with survival than the other factors.