Prolonged enteral feeding is often required to avoid long-term nutritional and metabolic complications after esophagogastric dissociation.
BACKGROUND
Total esophagogastric dissociation (TED) was first described in 1997 by Bianchi as a new surgical procedure to treat severe gastroesophageal reflux disease (GERD) in children with neurological impairment. Recently, TED has been proposed in other conditions, such as esophageal atresia, esotracheal cleft, or caustic esophageal lesions. Although the long-term results in terms of GERD control have been previously reported, those regarding the nutritional and metabolic status have never been documented.


METHODS
All patients without neurological impairment with TED between 1999 and 2004 at Robert Debre Hospital and Jeanne de Flandre Hospital, France, were prospectively investigated, paying particular attention to their metabolic and nutritional status (blood concentration of iron and vitamins A, D, E, and B12; lipid malabsorption; and hyperglycemia test) and growth.


RESULTS
Seventeen children underwent TED. Six received primary procedures, whereas 11 were operated on because of severe respiratory diseases or failure to thrive. The mean follow-up was 6 years (range 3-8 years). Two children died (12%). Seven children were weaned from enteral nutrition support, but 5 of them had failure to thrive, steatorrhea, and/or malabsorption of vitamin B12 and/or fat-soluble vitamins. Eight patients had dumping syndrome, which was symptomatic in 6 cases.


CONCLUSIONS
TED is an effective procedure for treatment of GERD. However, nutritional and metabolic complications including dumping syndrome and chronic digestive malabsorption are frequent after TED, especially after enteral nutrition weaning. A long-term follow-up of these patients is thus necessary and prolonged enteral nutrition support is recommended.
Madre
Chrystèle
C
Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Hôpital Robert Debré, Paris, France.
Serhal
Lydia
L
Michaud
Laurent
L
Bonnevalle
Michel
M
de Lagausie
Pascal
P
Gottrand
Frédéric
F
Bonnard
Arnaud
A
Hugot
Jean-Pierre
JP
D000293:Adolescent; D001361:Avitaminosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004377:Dumping Syndrome / Q000209:etiology / Q000628:therapy; D004750:Enteral Nutrition; D004947:Esophagus / Q000002:abnormalities / Q000601:surgery*; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008286:Malabsorption Syndromes / Q000209:etiology / Q000628:therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000628:therapy*; D012140:Respiratory Tract Diseases / Q000209:etiology; D045602:Steatorrhea / Q000209:etiology