title: Colonic conduit for esophageal replacement: long-term endoscopic and histopathologic changes in colonic mucosa.
abstract: BACKGROUND
  Long-term follow-up has substantiated the colon as a durable and highly acceptable esophageal substitute. Exposure of colonic conduit to gastric acid may lead to histopathologic changes in the form of chronic inflammation.
  
  
  METHODS
  Thirty children with esophageal replacement were studied from 2 to 12 years (mean, 5.20 years) postoperatively. All cases underwent upper gastrointestinal tract endoscopy to evaluate the gross appearance of colonic conduit mucosa, and punch biopsies were taken from upper and lower junctions of the conduit. All biopsies were submitted to histopathologic examination.
  
  
  RESULTS
  Endoscopic findings were comparable with normal regarding the gross appearance of colonic mucosa in both upper and lower junctions (25 cases/83.3%). Some abnormalities were seen including cervical anastomosis stricture (2 cases/6.7%), redundancy (3 cases/10%), mucosal ulcer in the lower residual esophagus (1 case/3.3%), and hyperemia (3 cases/10%). Pathologic changes were minimal regarding the change in position of the colon to a thoracic organ during follow-up. Most of the cases were normal (22 cases/73.3%). Seven cases (23.4%) showed mild chronic nonspecific inflammation of the colonic mucosa, whereas only 1 case (3.3%) showed mildly active inflammation of colonic mucosa.
  
  
  CONCLUSIONS
  The use of the colon for esophageal replacement showed that no significant pathologic changes affecting its function as a conduit because its mucosa showed no significant change in response to gastric acid reflux in long-term follow-up and can be further protected by an antireflux procedure.
authors.affiliation: Pediatric Surgery Unit and Pathology Department, Ain Shams University Hospital, Cairo, Egypt. hossamshafei@yahoo.com
authors.forename: Hossam
authors.initials: H
authors.lastname: Elshafei
authors.forename: Ehab
authors.initials: E
authors.lastname: Elshafei
authors.forename: Mohamed
authors.initials: M
authors.lastname: ElDebeiky
authors.forename: Nedal
authors.initials: N
authors.lastname: Hegazy
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zaki
authors.forename: Sameh
authors.initials: S
authors.lastname: Abdel Hay
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology / Q000637:transplantation*; D004933:Esophageal Atresia / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D013270:Stomach / Q000601:surgery; D016896:Treatment Outcome