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
Previously, esophageal replacement (ER) with gastric pull-up (GPU) or jejunal interposition (JI) used to be the standard treatment for long-gap esophageal atresia (LGEA). Gastrointestinal symptoms are common in EA patients and may occur even more frequently after ER, due to a change of the anatomy.
Long-term macroscopic and microscopic graft changes are currently unknown and may be clinically relevant in patients with LGEA.
This study aims to evaluate clinical symptoms and macroscopic and microscopic graft changes in adolescence and adulthood.
A cohort study including all LGEA patients ≥ 16 years who had undergone ER between 1985-2003 at two tertiary centers in the Netherlands was conducted. Clinical symptoms, contrast studies and endoscopies were collected prospectively.
Nine GPU patients and eleven JI patients were included in this study, with a median age of 21.5 years and 24.4 years respectively. Six of nine GPU patients (67%) reported reflux complaints and 64% of JI patients reported dysphagia symptoms. Dilatation of the jejunal graft was observed in 55%. Three GPU patients had columnar-lined epithelium and in two of these patients intestinal metaplasia was histologically confirmed.
Long-term follow-up revealed significant macroscopic and microscopic graft changes after ER. Furthermore, this study revealed long-term clinical symptoms after both GPU and JI. GPU patients may have an increased risk on intestinal metaplasia. Dilatation of the graft and dysphagia symptoms were present in the majority of JI patients. Follow-up during adulthood after ER for LGEA is therefore suggested.
This study highlights the importance of implementing an endoscopic follow-up program after ER for LGEA, particularly after GPU. Further investigations with larger patient cohorts are necessary to validate these findings.