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Eur J Pediatr Surg 2019; 29(04): 328-335
DOI: 10.1055/s-0039-1693992
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Esophageal Atresia: State of the Art in Translating Experimental Research to the Bedside

Nicholas E. Bruns 
1   Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, United States
,
Ian C. Glenn
1   Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, United States
,
Todd A. Ponsky
2   Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
› Author Affiliations
Further Information

Publication History

20 June 2019

25 June 2019

Publication Date:
19 August 2019 (online)

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Abstract

Long-gap esophageal atresia is one of the most challenging diseases in the field of pediatric surgery. There is no optimal therapy, and thus many potential therapies and techniques are being actively explored, both in animal models and in neonates. This article will review the available experimental treatment options with a focus on novel techniques.

Keywords

esophageal atresia - tracheoesophageal fistula - esophageal lengthening - esophageal replacement
 

  • References

  • 1 Depaepe A, Dolk H, Lechat MF. ; EUROCAT Working Group. The epidemiology of tracheo-oesophageal fistula and oesophageal atresia in Europe. Arch Dis Child 1993; 68 (06) 743-748
    CrossrefPubMedSearch in Google Scholar
  • 2 Spitz L. Oesophageal atresia. Orphanet J Rare Dis 2007; 2 (01) 24
    CrossrefPubMedSearch in Google Scholar
  • 3 Baird R, Lal DR, Ricca RL. , et al. Management of long gap esophageal atresia: a systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee. J Pediatr Surg 2019; 54 (04) 675-687
    CrossrefPubMedSearch in Google Scholar
  • 4 Engum SA, Grosfeld JL, West KW, Rescorla FJ, Scherer III LR. Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades. Arch Surg 1995; 130 (05) 502-508
    PubMedSearch in Google Scholar
  • 5 Friedmacher F, Puri P. Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome. Pediatr Surg Int 2012; 28 (09) 899-906
    CrossrefPubMedSearch in Google Scholar
  • 6 de Lorimier AA, Harrison MR. Long gap esophageal atresia: primary anastomosis after esophageal elongation by bougienage and esophagomyotomy. J Thorac Cardiovasc Surg 1980; 79 (01) 138-141
    CrossrefPubMedSearch in Google Scholar
  • 7 Hendren WH, Hale JR. Electromagnetic bougienage to lengthen esophageal segments in congenital esophageal atresia. N Engl J Med 1975; 293 (09) 428-432
    CrossrefPubMedSearch in Google Scholar
  • 8 Sauer H, Kurz R. Experiences in the treatment of esophageal atresia with Rehbein's olive technique. Prog Pediatr Surg 1986; 19: 93-102
    PubMedSearch in Google Scholar
  • 9 von Allmen D, Wijnen RM. ; Allmen von D. Bridging the gap in the repair of long-gap esophageal atresia: still questions on diagnostics and treatment. Eur J Pediatr Surg 2015; 25 (04) 312-317
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Bruns NE, Glenn IC, Craner DR, Schomisch SJ, Harrison MR, Ponsky TA. Magnetic compression anastomosis (magnamosis) in a porcine esophagus: proof of concept for potential application in esophageal atresia. J Pediatr Surg 2019; 54 (03) 429-433
    CrossrefPubMedSearch in Google Scholar
  • 11 Jensen T, Wanczyk H, Sharma I, Mitchell A, Sayej WN, Finck C. Polyurethane scaffolds seeded with autologous cells can regenerate long esophageal gaps: an esophageal atresia treatment model. J Pediatr Surg 2018 Doi: 10.1016/j.jpedsurg.2018.09.024
    PubMedSearch in Google Scholar
  • 12 Glenn IC, Bruns NE, Gabarain G, Craner DR, Schomisch SJ, Ponsky TA. Creation of an animal model for long gap pure esophageal atresia. Pediatr Surg Int 2017; 33 (02) 197-201
    CrossrefPubMedSearch in Google Scholar
  • 13 Glenn IC, Bruns NE, Schomisch SJ, Ponsky TA. Creation of an esophageal atresia animal model using a bifurcated esophagus to maintain digestive tract continuity. J Laparoendosc Adv Surg Tech A 2017; 27 (10) 1079-1084
    CrossrefPubMedSearch in Google Scholar
  • 14 Oetzmann von Sochaczewski C, Lindner A, Heimann A. , et al. Beyond magnamosis: a method to test sutureless esophageal anastomotic devices in living swine by creating an esophageal bypass loop for natural oral nutrition. J Laparoendosc Adv Surg Tech A 2019; 29 (06) 852-855
    CrossrefPubMedSearch in Google Scholar
  • 15 Usui Y, Ono S. Impact of botulinum toxin A injection on esophageal anastomosis in a rabbit model. Pediatr Surg Int 2016; 32 (09) 881-886
    CrossrefPubMedSearch in Google Scholar
  • 16 Urbani L, Camilli C, Phylactopoulos D-E. , et al. Multi-stage bioengineering of a layered oesophagus with in vitro expanded muscle and epithelial adult progenitors. Nat Commun 2018; 9 (01) 4286
    CrossrefPubMedSearch in Google Scholar
  • 17 Sullins VF, Traum PK, French SW, Wu BM, Dunn JCY, Lee SL. A novel method of esophageal lengthening in a large animal model of long gap esophageal atresia. J Pediatr Surg 2015; 50 (06) 928-932
    CrossrefPubMedSearch in Google Scholar
  • 18 Soyer T, Kalkışım S, Yalcin S. , et al. The effects of acute tension increase on rat esophageal muscle contractions: an in vitro study. J Pediatr Surg 2015; 50 (10) 1691-1694
    CrossrefPubMedSearch in Google Scholar
  • 19 Inoue S, Kosaka T, Takatsuki M, Kuroki T, Eguchi S. Histological study of the elongated esophagus in a rat model. J Surg Res 2015; 195 (02) 495-501
    CrossrefPubMedSearch in Google Scholar
  • 20 Hays DM, Woolley MM, Snyder Jr WH. Changing techniques in the management of esophageal atresia. Arch Surg 1966; 92 (04) 611-616
    PubMedSearch in Google Scholar
  • 21 Mahour GH, Woolley MM, Gwinn JL. Elongation of the upper pouch and delayed anatomic reconstruction in esophageal atresia. J Pediatr Surg 1974; 9 (03) 373-383
    CrossrefPubMedSearch in Google Scholar
  • 22 Zaritzky M, Ben R, Zylberg GI, Yampolsky B. Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia. Pediatr Radiol 2009; 39 (09) 945-949
    CrossrefPubMedSearch in Google Scholar
  • 23 Larsen HF, Jensen TSR, Rasmussen L, Ellebæk M, Qvist N. Intramural injection with botulinum toxin significantly elongates the pig esophagus. J Pediatr Surg 2013; 48 (10) 2032-2035
    CrossrefPubMedSearch in Google Scholar
  • 24 Ellebæk M, Qvist N, Rasmussen L. Secondary anastomosis after preoperative botulinum type A toxin injection in a case with long gap oesophageal atresia. Eur J Pediatr Surg 2013; 23 (04) 325-326
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Foker JE, Linden BC, Boyle Jr EM, Marquardt C. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 1997; 226 (04) 533-541
    CrossrefPubMedSearch in Google Scholar
  • 26 Foker JE, Kendall TC, Catton K, Khan KM. A flexible approach to achieve a true primary repair for all infants with esophageal atresia. Semin Pediatr Surg 2005; 14 (01) 8-15
    CrossrefPubMedSearch in Google Scholar
  • 27 Khan KM, Sabati AA, Kendall T, Foker JE. The effect of traction on esophageal structure in children with long-gap esophageal atresia. Dig Dis Sci 2006; 51 (11) 1917-1921
    CrossrefPubMedSearch in Google Scholar
  • 28 van der Zee DC, Gallo G, Tytgat SHA. Thoracoscopic traction technique in long gap esophageal atresia: entering a new era. Surg Endosc 2015; 29 (11) 3324-3330
    CrossrefPubMedSearch in Google Scholar
  • 29 Kimura K, Soper RT. Multistaged extrathoracic esophageal elongation for long gap esophageal atresia. J Pediatr Surg 1994; 29 (04) 566-568
    CrossrefPubMedSearch in Google Scholar
  • 30 Tamburri N, Laje P, Boglione M, Martinez-Ferro M. Extrathoracic esophageal elongation (Kimura's technique): a feasible option for the treatment of patients with complex esophageal atresia. J Pediatr Surg 2009; 44 (12) 2420-2425
    CrossrefPubMedSearch in Google Scholar
  • 31 Vogel AM, Yang EY, Fishman SJ. Hydrostatic stretch-induced growth facilitating primary anastomosis in long-gap esophageal atresia. J Pediatr Surg 2006; 41 (06) 1170-1172
    CrossrefPubMedSearch in Google Scholar
  • 32 Scott A, Sullins VF, Steinberger D. , et al. Repeated mechanical lengthening of intestinal segments in a novel model. J Pediatr Surg 2015; 50 (06) 954-957
    CrossrefPubMedSearch in Google Scholar
  • 33 Rehbein F, Schweder N. Reconstruction of the esophagus without colon transplantation in cases of atresia. J Pediatr Surg 1971; 6 (06) 746-752
    CrossrefPubMedSearch in Google Scholar
  • 34 Zaritzky M, Ben R, Johnston K. Magnetic gastrointestinal anastomosis in pediatric patients. J Pediatr Surg 2014; 49 (07) 1131-1137
    CrossrefPubMedSearch in Google Scholar
  • 35 Ellebaek MBB, Qvist N, Rasmussen L. Magnetic compression anastomosis in long-gap esophageal atresia gross type A: a case report. European J Pediatr Surg Rep 2018; 6 (01) e37-e39
    Thieme ConnectPubMedSearch in Google Scholar
  • 36 Shieh HF, Jennings RW. Long-gap esophageal atresia. Semin Pediatr Surg 2017; 26 (02) 72-77
    CrossrefPubMedSearch in Google Scholar
  • 37 Spitz L. Gastric transposition via the mediastinal route for infants with long-gap esophageal atresia. J Pediatr Surg 1984; 19 (02) 149-154
    CrossrefPubMedSearch in Google Scholar
  • 38 Spitz L, Kiely E, Pierro A. Gastric transposition in children--a 21-year experience. J Pediatr Surg 2004; 39 (03) 276-281
    CrossrefPubMedSearch in Google Scholar
  • 39 Ure BM, Jesch NK, Sümpelmann R, Nustede R. Laparoscopically assisted gastric pull-up for long gap esophageal atresia. J Pediatr Surg 2003; 38 (11) 1661-1662
    CrossrefPubMedSearch in Google Scholar
  • 40 Heimlich HJ, Winfield JM. The use of a gastric tube to replace or by-pass the esophagus. Surgery 1955; 37 (04) 549-559
    PubMedSearch in Google Scholar
  • 41 Anderson KD, Randolph JG. The gastric tube for esophageal replacement in children. J Thorac Cardiovasc Surg 1973; 66 (03) 333-342
    CrossrefPubMedSearch in Google Scholar
  • 42 German JC, Waterston DJ. Colon interposition for the replacement of the esophagus in children. J Pediatr Surg 1976; 11 (02) 227-234
    CrossrefPubMedSearch in Google Scholar
  • 43 Esteves E, Sousa-Filho HB, Watanabe S, Silva JF, Neto EC, da Costa AL. Laparoscopically assisted esophagectomy and colon interposition for esophageal replacement in children: preliminary results of a novel technique. J Pediatr Surg 2010; 45 (05) 1053-1060
    CrossrefPubMedSearch in Google Scholar
  • 44 Ring WS, Varco RL, L'Heureux PR, Foker JE. Esophageal replacement with jejunum in children: an 18 to 33 year follow-up. J Thorac Cardiovasc Surg 1982; 83 (06) 918-927
    CrossrefPubMedSearch in Google Scholar
  • 45 Bax NMA, Van Renterghem KM. Ileal pedicle grafting for esophageal replacement in children. Pediatr Surg Int 2005; 21 (05) 369-372
    CrossrefPubMedSearch in Google Scholar
  • 46 Bax NMA, van der Zee DC. Jejunal pedicle grafts for reconstruction of the esophagus in children. J Pediatr Surg 2007; 42 (02) 363-369
    CrossrefPubMedSearch in Google Scholar
  • 47 Saitua F, Madrid A, Capdeville F, Ferrada C, Herrera P. Pharyngo-esophageal reconstruction by free jejunal graft and microvascular anastomosis in a 10-year-old girl. J Pediatr Surg 2004; 39 (07) e10-e12
    CrossrefPubMedSearch in Google Scholar
  • 48 Rayyan M, Rommel N, Tack J, Deprest J, Allegaert K. Esophageal atresia: future directions for research on the digestive tract. Eur J Pediatr Surg 2017; 27 (04) 306-312
    Thieme ConnectPubMedSearch in Google Scholar
  • 49 Hendren WH, Hale JR. Esophageal atresia treated by electromagnetic bougienage and subsequent repair. J Pediatr Surg 1976; 11 (05) 713-722
    CrossrefPubMedSearch in Google Scholar