Erudition after neonatal gastric transposition for esophageal atresia at 10 years of follow-up
Keywords:Esophageal replacement, Gastric transposition, Neonate, Gastric pull up
Background: Gastric transposition (GT) is a well-established procedure of esophageal replacement (ER) for children with esophageal atresia. ER in the neonatal period is sparsely reported. We report characteristics of children who have undergone neonatal GT and have completed ten years of follow-up.
Methods: The cross-sectional study was conducted which included all children who underwent neonatal GT at the institute and have completed a follow-up of at least 10-years. Anthropometry, oral contrast study, Hepatobiliary Scintigraphy, Gastroesophageal reflux study, Gastric emptying test, spirometry, and blood investigations were done for all the children.
Results: Four children (three male and one female) were included in the study. The mean age at ER was 5.3 ±2.2 days with a mean birth-weight of 2.43 ±0.13 kg. Two children had primary GT, while the other two had GT following a leak in primary anastomosis. During the mean follow-up of 180.25 ±43.5 months, none of the children required esophageal dilatation or other surgical intervention or procedures. All children were below 3rd centile for weight-for-age while all except one were below 50th centile for height-for-age. There was no stricture on oral contrast study, however, one child had grade III reflux on GER scan. Persistent duodenogastric reflux on HIDA scan was seen in one child. Three children had restrictive parameters on spirometry. Symptomatically, all reported poor weight gain, one had left vocal cord palsy with hoarseness, and one had chest-wall protuberance.
Conclusions: Neonatal gastric transposition is a feasible alternative to delayed esophageal replacement for neonates with esophageal atresia with limited complications.
Shieh HF, Jennings RW. Long-gap esophageal atresia. Semin Pediatr Surg. 2017; 26:72-7.
Kunisaki SM, Coran AG. Esophageal replacement. Semin Pediatr Surg. 2017; 26:105-15.
Sharma S, Gupta DK. Surgical techniques for esophageal replacement in children. Pediatr Surg Int. 2017; 33:527-50.
Zeng Z, Liu F, Ma J, Fang Y, Zhang H. Outcomes of primary gastric transposition for long-gap esophageal atresia in neonates. Medicine (Baltimore). 2017; 96:e7366.
Gupta DK, Sharma S. Esophageal substitution for esophageal atresia: experience with neonatal gastric transposition. Pediatr Health. 2008; 2:453-62.
Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, Cherian A, et al. Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children. Indian Pediatr. 2015; 52:47-55.
Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005; 86:1516–20
Spitz L. Oesophageal atresia. Orphanet J Rare Dis. 2007; 2:24.
Reusens H, Matthyssens L, Vercauteren C, van Renterghem K. Multicentre survey on the current surgical management of oesophageal atresia in Belgium and Luxembourg. J Pediatr Surg. 2017; 52:239-46.
Spitz L. Gastric transposition in children. Semin Pediatr Surg. 2009; 18:30-3.
Sharma S, Gupta DK. Primary gastric pull-up in pure esophageal atresia: technique, feasibility and outcome. A prospective observational study. Pediatr Surg Int. 2011; 27:583-5.
Holland AJA, Ron O, Pierro A, Drake D, Curry JI, Kiely EM, et al. Surgical outcomes of esophageal atresia without fistula for 24 years at a single institution. J Pediatr Surg. 2009; 44:1928-32.
Choudhury S, Yadav PS, Khan NA, Shah S, Debnath PR, Kumar V et al. Pediatric esophageal substitution by gastric pull-up and gastric tube. J Indian Assoc Pediatr Surg. 2016; 21:110.
Gupta DK, Sharma S. Esophageal atresia: the total care in a high-risk population. Semin Pediatr Surg. 2008; 17:236-43.
Gupta DK, Sharma S, Arora MK, Agarwal G, Gupta M, Grover VP. Esophageal replacement in the neonatal period in infants with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 2007; 42:1471-7.
Gupta D, Srinivas M, Agarwala S, Dave S, Arora M, Gupta A et al. Neonatal gastric pull up: reality or myth? Pediatr Surg Int. 2003; 19:100-3.
Jain V, Sharma S, Kumar R, Kabra SK, Bhatia V, Gupta DK. Transposed intrathoracic stomach: functional evaluation. Afr J Paediatr Surg. 2012; 9:210-6.
Shawyer AC, Pemberton J, Flageole H. Post-operative management of esophageal atresia–tracheoesophageal fistula and gastroesophageal reflux: A Canadian Association of Pediatric Surgeons annual meeting survey. J Pediatr Surg. 2014; 49:716-9.
Garritano S, Irino T, Scandavini CM, Tsekrekos A, Lundell L, Rouvelas I. Long-term functional outcomes after replacement of the esophagus in pediatric patients: A systematic literature review. J Pediatr Surg. 2017; 52:1398-408.
Acher C, Ostlie D, Leys C, Struckmeyer S, Parker M, Nichol P. Long-term outcomes of patients with tracheoesophageal fistula/esophageal atresia: Survey results from tracheoesophageal fistula/esophageal atresia online communities. Eur J Pediatr Surg. 2015; 26:476-80.
Gallo G, Zwaveling S, Groen H, Van der Zee D, Hulscher J. Long-gap esophageal atresia: A meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur J Pediatr Surg. 2012; 22:420-5.
Spitz L, Kiely E, Pierro A. Gastric transposition in children—a 21-year experience. J Pediatr Surg. 2004; 39:276-81.
Hirschl RB, Yardeni D, Oldham K, Sherman N, Siplovich L, Gross E, et al. Gastric transposition for esophageal replacement in children. Ann Surg. 2002; 236:1.
Rintala RJ, Sistonen S, Pakarinen MP. Outcome of oesophageal atresia beyond childhood: J Pediatr Gastroenterol Nutr. 2011; 52:S35-6.
Dittrich R, Stock P, Rothe K, Degenhardt P. Pulmonary outcome of esophageal atresia patients and its potential causes in early childhood. J Pediatr Surg. 2017; 52:1255-9.
Davenport M, Hosie GP, Tasker RC, Gordon I, Kiely EM, Spitz L. Long-term effects of gastric transposition in children: A physiological study. J Pediatr Surg. 1996; 31:588-93.
Molinaro F, Angotti R, Bindi E, Pellegrino C, Casini L, Messina M, et al. An European multicentric study of esophageal replacements: gastric pull-up, jejunal interposition, colonic interposition. Allied J Clin Path. 2017; 1:9-12.
Ludman L, Spitz L. Quality of life after gastric transposition for oesophageal atresia. J Pediatr Surg. 2003; 38:53-7.
How to Cite
Copyright (c) 2021 Kanika Sharma, Shilpa Sharma, Devendra Kumar Gupta
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.