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DOI: 10.1055/s-0030-1267240
© Georg Thieme Verlag KG Stuttgart · New York
Long-Term Follow-up of Patients with Esophageal Replacement by Reversed Gastric Tube
Publikationsverlauf
received April 07, 2010
accepted after revision August 16, 2010
Publikationsdatum:
05. November 2010 (online)
![](https://www.thieme-connect.de/media/ejps/201102/lookinside/thumbnails/10.1055-s-0030-1267240-1.jpg)
Abstract
Purpose: Various surgical procedures are used for esophageal substitution in children. The purpose of this study was to evaluate the long-term outcome in children who underwent esophageal replacement by reversed gastric tube and to assess some aspects of the physiological function and behavior of the reversed gastric tube.
Methods: This study was a retrospective and prospective review of 16 patients who had undergone reversed gastric tube esophagoplasty between March 1990 and March 2009. Indications for esophageal replacement included esophageal atresia with or without fistula (10) and caustic injury (6). There were 10 boys and 6 girls. Age at the time of this study varied from 1.7–20 years. The interval between operation and follow-up varied; it was more than 3 months in all cases, with an average of 8 months. Follow-up studies included clinical evaluation, anthropometry, barium study (to look for anastomotic leak, stricture, passage of contrast, ulcer, diverticulum, peristalsis and emptying), neoesophagus motility patterns by manometry, 24-h pH monitoring and radionuclide studies (to investigate esophageal transit and gastric emptying times and gastroesophageal reflux). Statistical analysis was carried out using STATA 9.0 and continuous variables were compared between the tests using the Wilcoxon rank sum test.
Results: Of the 16 children, 12 were between the 3rd and 97th percentiles for weight and 10 were between the 3rd and 97th percentiles for height for their respective age group. 14 were eating and swallowing normally. 2 patients had slight swallowing difficulties with lumpy foods but did not require dilatations. None of our patients had respiratory problems. The children with corrosive stricture were almost normal in growth and development compared to esophageal atresia patients. Barium swallow showed normal swallowing in all patients and did not show gastroesophageal reflux. Mass contractions were seen in two-thirds of the patients on manometry. 24-h pH monitoring showed that the intraluminal pH remained consistently low, even long after operative treatment. Scintigraphy and barium swallow showed almost similar results except that scintigraphy was much more sensitive in detecting reflux.
Conclusion: Almost all children remained asymptomatic and led a normal life. The function of the neoesophagus was good and growth and nutrition in the majority of patients was satisfactory.
Key words
reversed gastric tube - esophageal replacement - anthropometry - barium swallow - neoesophageal manometry - 24h pH monitoring - radionuclide scintigraphy
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Correspondence
Prof. Veereshwar BhatnagarMBBS, MS, MCh
All India Institute of Medical
Sciences
Pediatric Surgery
Ansari Nagar
110029 New Delhi
India
Telefon: +91 11 265 93309
Fax: +91 11 265 88663
eMail: veereshwarb@hotmail.com