Long-term outcome of colon interposition after esophagectomy in children.
OBJECTIVE
Tissues derived from the colon, stomach, and jejunum have been used to replace the esophagus in childhood to cure esophageal atresia or stricture secondary to gastroesophageal reflux or the ingestion of corrosive agents. The outcome in adulthood of colon interposition performed at an early age has yet to be satisfactorily assessed. The aim of this single-center retrospective study was to evaluate the long-term nutritional, digestive, and respiratory outcome of all patients (n = 32) who underwent colon interposition during childhood in our hospital (1970-2001).


METHODS
Medical records of these subjects were reviewed and their nutritional (weight, height, 24-hour food diary), digestive (questionnaire), and pulmonary function status evaluated.


RESULTS
Of the patients, 17 had esophageal atresia (7 males, median age at surgery 11 months, range 0.5-61) and 15 had ingested corrosive substances (10 males, median age at surgery 50 months, range 22-113). Complications occurred less than 1 year postoperatively in 53% and long-term complications (occurring >1 year after surgery) in 84%. Long-term complications were common: digestive symptoms were found in 85% (most frequently observed during the first 5 years of follow-up), abnormal lung function in 7 (58%) of those tested (n = 12), feeding difficulties in 50%, scoliosis in 35%, and nutritional complications in 25%.


CONCLUSIONS
Our study showed a high rate of sequelae following esophageal replacement. This highlights the need for multidisciplinary long-term follow-up into adulthood, and research into alternatives to colon interposition as treatment for esophageal strictures.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Lille University Hospital, Lille, France.
S
S
Coopman
L
L
Michaud
M
M
Halna-Tamine
M
M
Bonnevalle
B
B
Bourgois
D
D
Turck
F
F
Gottrand
D000293:Adolescent; D002424:Caustics / Q000633:toxicity; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology / Q000601:surgery / Q000637:transplantation*; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D002424:Caustics