Manometric evaluation of the intrathoracic stomach after gastric transposition in children

Abstract

Gastric transposition (GT) is one of the options for the esophageal replacement in children with esophageal atresia with or without tracheoesophageal fistula (EATEF). To date, no manometric studies have been conducted on the intrathoracic stomach after GT in EATEF patients; hence, this study was designed. Babies ( n=18) of EATEF who underwent esophageal replacement by GT were studied and manometry was correlated with the clinical outcome, age at surgery, and route of GT. The mean age at evaluation was 30.5 months (range 4-84 months). These cases were sub-stratified into group I (GT during neonatal period) and group II (GT during post-neonatal period). Mean age at surgery was 6 days and 7.8 months in groups I and II, respectively. There was no propulsive antegrade propagated peristaltic waves in any of the patients. Mean resting pressure and mean peak pressures were 19.5 and 50.4 mm Hg in groups I and II, respectively. Mass contractions to liquid swallow was noted in 77 and 55% of patients in groups I and II, respectively. There was no significant difference in the pressure parameters or appearance of mass contractions between group-I and group-II patients. Similarly, there was no significant difference in pressure parameters or appearance of mass contractions between the children who had transhiatal vs retrosternal GT. It needs to be determined whether the mass contractions noted in GT ever progress to a coordinated propulsive rhythmic contractions and whether this has a final bearing on the long-term functional outcome of GT patients.

Esophageal replacement in the neonatal period in infants with esophageal atresia and tracheoesophageal fistula

“…The mean resting pressure in patients in whom gastric transposition was done in the neonatal period was 19.5 mm Hg [20]. The pH usually rises to 4 to 4.5 after vagotomy so was noted in most of our patients.…”

A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia

“…There is evidence of swallow-related motor activity in the stomach after GPU, although a propagated antegrade propulsive peristalsis does not seem to be present [15]. Rather than a reservoir, the transposed stomach seems to act like a conduit with an extremely irregular biphasic emptying pattern.…”

Ileal pedicle grafting for esophageal replacement in children

“…When using stomach, the same holds true [12]. Moreover, the bulkiness of the stomach may interfere with lung development, especially in infants.…”