Esophageal replacements in children

Reinberg, Olivier

doi:10.1111/nyas.13101

Cited by 12 publications

(3 citation statements)

References 29 publications

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“…However, in contrast [ 18 , 19 ], genetic disorders were similarly present in children with DREA and PA. In our study sample, 25% of children aged 2–7 and 54% of those aged 8–18 had DPA, which has been advocated as the best choice in LGEA [ 46 , 47 ]. Evidence for one conduit being superior to another is weak [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 92%

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Dellenmark‐Blom

Öst

et al. 2022

Orphanet J Rare Dis

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Background In 10–15% of children with esophageal atresia (EA) delayed reconstruction of esophageal atresia (DREA) is necessary due to long-gap EA and/or prematurity/low birth weight. They represent a patient subgroup with high risk of complications. We aimed to evaluate postoperative morbidity and health-related quality of life (HRQOL) in a Swedish national cohort of children with DREA. Methods Postoperative morbidity, age-specific generic HRQOL (PedsQL™ 4.0) and condition-specific HRQOL (The EA-QOL questionnaires) in children with DREA were compared with children with EA who had primary anastomosis (PA). Factors associated with the DREA group’s HRQOL scores were analyzed using Mann–Whitney U-test and Spearman’s rho. Clinical data was extracted from the medical records. Significance level was p < 0.05. Results Thirty-four out of 45 families of children with DREA were included and 30 returned the questionnaires(n = 8 children aged 2–7 years; n = 22 children aged 8–18 years). Compared to children with PA(42 children aged 2–7 years; 64 children aged 8–18 years), there were no significant differences in most early postoperative complications. At follow-up, symptom prevalence in children aged 2–7 with DREA ranged from 37.5% (heartburn) to 75% (cough). Further digestive and respiratory symptoms were present in ≥ 50%. In children aged 8–18, it ranged from 14.3% (vomiting) to 40.9% (cough), with other digestive and airway symptoms present in 19.0–27.3%. Except for chest tightness (2–7 years), there were no significant differences in symptom prevalence between children with DREA and PA, nor between their generic or condition-specific HRQOL scores (p > 0.05). More children with DREA underwent esophageal dilatations (both age groups), gastrostomy feeding (2–7 years), and antireflux treatment (8–18 years), p < 0.05. Days to hospital discharge after EA repair and a number of associated anomalies showed a strong negative correlation with HRQOL scores (2–7 years). Presence of cough, airway infection, swallowing difficulties and heartburn were associated with lower HRQOL scores (8–18 years), p < 0.05. Conclusions Although children with DREA need more treatments, they are not a risk group for postoperative morbidity and impaired HRQOL compared with children with PA. However, those with a long initial hospital stay, several associated anomalies and digestive or respiratory symptoms risk worse HRQOL. This is important information for clinical practice, families and patient stakeholders.

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Section: Discussionmentioning

confidence: 92%

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Dellenmark‐Blom

Öst

et al. 2022

Orphanet J Rare Dis

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“…In patients where conventional management fails, gastric transposition and colonic interposition grafts are used to replace diseased esophageal segments (Ezemba et al, 2014). However, these procedures can lead to severe adverse events such as esophageal dysmotility, anastomotic leakage, and donor site morbidity, all of which can negatively impact patient quality of life (Reinberg, 2016). Matrices derived from decellularized tissues or synthetic polymers have been previously investigated as alternatives to autologous gastrointestinal segments in both animal models and clinical settings of esophageal reconstruction (Badylak et al, 2000, 2011; Aikawa et al, 2013; Dua et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Bilayer silk fibroin grafts support functional oesophageal repair in a rodent model of caustic injury

Algarrahi

Franck

Savarino

et al. 2017

J Tissue Eng Regen Med

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Surgical repair of caustic oesophageal injuries with autologous gastrointestinal segments is often associated with dysmotility, dysphagia and donor site morbidity, and therefore alternative graft options are needed. Bilayer silk fibroin (BLSF) scaffolds were assessed for their ability to support functional restoration of damaged oesophageal tissues in a rat model of onlay oesophagoplasty. Transient exposure of isolated oesophageal segments with 40% NaOH led to corrosive oesophagitis and a 91% reduction in the luminal cross-sectional area of damaged sites. Oesophageal repair with BLSF matrices was performed in injured rats (n = 27) as well as a nondiseased cohort (n = 12) for up to 2 months after implantation. Both implant groups exhibited >80% survival rates, displayed similar degrees of weight gain, and were capable of solid food consumption following a 3-day liquid diet. End-point μ-computed tomography of repaired sites demonstrated a 4.5-fold increase in luminal cross-sectional area over baseline injury levels. Reconstructed oesophageal conduits from damaged and nondiseased animals produced comparable contractile responses to KCl and electric field stimulation while isoproterenol generated similar tissue relaxation responses. Histological and immunohistochemical evaluations of neotissues from both implant groups showed formation of a stratified, squamous epithelium with robust cytokeratin expression as well as skeletal and smooth muscle layers positive for contractile protein expression. In addition, synaptophysin positive neuronal junctions and vessels lined with CD31 positive endothelial cells were also observed at graft sites in each setting. These results provide preclinical validation for the use of BLSF scaffolds in reconstructive strategies for oesophageal repair following caustic injury.

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“…Así como existe la opción de varios tipos de injertos, existen varias localizaciones para alojar el injerto, que incluyen preesternal, retroesternal, transpleural y el mediastino posterior o posición ortotópica 3 . Esta última localización es la más corta y recta 13 , por lo que fue la empleada en este paciente.…”

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Reemplazo esofágico mínimamente invasivo con tubo de Akiyama en un paciente pediátrico con quemadura esofágica

Salazar-Palacio,

Rosales-Parra,

Molina-Valencia

et al. 2023

Rev Colomb Cir

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Introducción. La ingesta de cáusticos continúa siendo un problema de salud pública en los países en vía de desarrollo, por lo que a veces es necesario realizar un reemplazo esofágico en estos pacientes. Aún no existe una técnica estandarizada para este procedimiento. Caso clínico. Masculino de 10 años con estenosis esofágica por ingesta de cáusticos, quien no mejoró con las dilataciones endoscópicas. Se realizó un ascenso gástrico transhiatal por vía ortotópica mediante cirugía mínimamente invasiva como manejo quirúrgico definitivo. Discusión. Actualmente existen varios tipos de injertos usados en el reemplazo esofágico. La interposición colónica y gástrica son las que cuentan con mayores estudios, mostrando resultados similares. Conclusiones. La elección del tipo y posición del injerto debe ser individualizada, tomando en cuenta las características de las lesiones y la anatomía de cada paciente para aumentar la tasa de éxito.

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Esophageal replacements in children

Cited by 12 publications

References 29 publications

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

Bilayer silk fibroin grafts support functional oesophageal repair in a rodent model of caustic injury

Reemplazo esofágico mínimamente invasivo con tubo de Akiyama en un paciente pediátrico con quemadura esofágica

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