Quality of life after esophageal replacement in children

Abstract

Assessing quality of life (QoL) after esophageal replacement (ER) for long gap esophageal atresia (LGEA). Methods: All patients after ER for LGEA with gastric pull-up (GPU n = 9) or jejunum interposition (JI n = 14) at the University Medical Center Groningen and Utrecht (1985-2007) were included. QoL was assessed with 1) gastrointestinal-related QoL using the Gastrointestinal Quality of Life Index (GIQLI)), 2) general QoL (Child Health questionnaire CHF87-BREF (children)/World Health Organization questionnaire WHOQOL-BREF (adults)), and 3) health-related QoL (HRQoL) (TNO AZL TACQoL/TAAQoL). Association of morbidity (heartburn, dysphagia, dyspnea on exertion, recurrent cough) and (HR)QoL was evaluated. Results: Six patients after GPU (75%) and eight patients after JI (57%) responded to the questionnaires (mean age 15.7, SD 5.9, 12 male, two female). Mean gastrointestinal, general and health-related QoL total scores of the patients were comparable to healthy controls. However, young adults reported a worse physical functioning (p = 0.02) but better social functioning compared to peers (p = 0.01). Morbidity was not associated with significant differences in (HR)QoL. Conclusions: With the current validated QoL most patients after ER with GPU and JI for LGEA have normal generic and disease specific QoL scores. Postoperative morbidity does not seem to influence (HR)QoL.

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

“…In children aged 8-18 with DREA, the presence of digestive or respiratory symptoms were associated with worse generic and/or condition-speci c HRQOL, as in children with EA in general [42,54,60]. Like Gallo et al [34], we could not con rm a relationship between esophageal dilatations and HRQOL. Although esophageal dilatations may re ect disease severity, treatment aims to relieve troublesome symptoms [61], which could be a reason for our ndings.…”

“…LGEA/complicated EA and those with PA or with healthy references [32,[34][35][36]. Although these studies differ in design, recruitment strategies, HRQOL assessments and subgroups of children with LGEA/complex EA, they all focus on a complicated group of patients with EA.…”

“…Although these studies differ in design, recruitment strategies, HRQOL assessments and subgroups of children with LGEA/complex EA, they all focus on a complicated group of patients with EA. As previously discussed [34,36,54-56], the HRQOL results may be explained by the congenital nature of EA, where disease-related challenges become a part of the children's identity [57] and adaptation [58,59]. There are only two studies of coping used by children with EA [58,59], and these demonstrate that already as toddlers they use coping strategies in several disease-speci c contexts.…”

“…One study demonstrated worse generic HRQOL in preschool children with isolated EA vs those with EA and distal TEF [33]. Other studies found similar HRQOL in EA children with jejunal interposition, gastric pull-up (GPU) [34] and thoracoscopic external traction technique[35] compared with healthy children. Another study showed higher HRQOL scores in EA children with DPA vs children with ER and healthy references [36].…”

What is the Best Choice for Esophageal Replacement in Children?

“…Dilatation of thoracic inlet by resection of left half of manubrium and internal third of clavicle reduces the risk of cervical anastomosis leakage [48]. Because the lack of longterm comparative study about the advantages and disadvantages of different types of esophageal replacement, and proper prospective comparative studies are absent, it seems we cannot significantly introduce the method of choice in patients and it mostly depends on the surgeon's skills and selections [49]. Further studies are needs for this decision making [50].…”