Published online Sep 16, 2023. doi: 10.4253/wjge.v15.i9.553
Peer-review started: April 5, 2023
First decision: June 1, 2023
Revised: June 15, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: September 16, 2023
Esophageal replacement (ER) with gastric pull-up (GPU) or jejunal interposition (JI) used to be the standard treatment for long-gap esophageal atresia (LGEA). Changes of the ER grafts on a macro- and microscopic level however, are un
To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.
A cohort study was conducted including all LGEA patients ≥ 16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands. Patients underwent clinical assessment, contrast study and endoscopy with biopsy. Data was collected prospectively. Group differences between JI and GPU patients, and associations between different outcome measures were assessed using the Fisher’s exact test for bivariate variables and the Mann-Whitney U-test for continuous variables. Differences with a P-value < 0.05 were considered statistically significant.
Nine GPU patients and eleven JI patients were included. Median age at follow-up was 21.5 years and 24.4 years, respectively. Reflux was reported in six GPU patients (67%) vs four JI patients (36%) (P = 0.37). Dysphagia symptoms were reported in 64% of JI patients, compared to 22% of GPU patients (P = 0.09). Contrast studies showed dilatation of the jejunal graft in six patients (55%) and graft lengthening in four of these six patients. Endoscopy revealed columnar-lined esophagus in three GPU patients (33%) and intestinal metaplasia was histologically confirmed in two patients (22%). No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia. Three GPU patients (33%) experienced severe feeding problems vs none in the JI group. The median body mass index of JI patients was 20.9 kg/m2vs 19.5 kg/m2 in GPU patients (P = 0.08).
The majority of GPU patients had reflux and intestinal metaplasia in 22%. The majority of JI patients had dys
Core Tip: Long-gap esophageal atresia (LGEA) remains a surgical challenge. Preservation of the native esophagus in LGEA is the treatment of choice. Previously however, almost all LGEA patients underwent esophageal replacement (ER). This study evaluated long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA. We found that long-term symptoms and graft alterations were common. The majority of gastric pull-up patients had reflux symptoms with intestinal metaplasia in 22%. The majority of jejunal interposition (JI) patients had dysphagia symptoms and more than half of the JI grafts were dilated.