Outcomes in Adulthood of Gastric Transposition for Complex and Long Gap Esophageal Atresia
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In brief
In brief
This retrospective study of 32 adults who underwent gastric transposition for complex esophageal atresia in childhood reveals significant long-term morbidity including nutritional challenges, chronic respiratory disease, and mental health issues. While quality of life was comparable to primary repair patients, 19% still required supplementary feeding and one-third experienced anastomotic strictures, emphasizing the need for lifelong specialized follow-up.
Written by the GCMD Library team from the article.
Background
Long term outcomes of gastric transposition (GT) for complex esophageal atresia (EA) are poorly reported. We aimed to perform comprehensive long term follow up of adults who had been treated with GT for EA as children.
Methods
Consecutive patients who underwent GT for EA in childhood aged >18 years old were identified alongside age matched patients who had primary repair (PR). Type of EA, comorbidities and details of surgery were recorded. Telephone interviews included medical history, current symptoms — including gastrointestinal symptom rating scale (GSRS), morbidity and health related quality of life (HRQoL) using gastrointestinal quality of life index (GIQLI).
Results
32 participants were interviewed in each group (mean age 29 years). BMI (19.9 ± 3.5) was significantly lower (p = 0.0006) in GT group. 6/32 (19%) still required supplementary feeding. Adult morbidity included anastomotic stricture (34%), chronic respiratory disease (28%), dumping symptoms (25%), anemia (47%) and depression (19%). 3 patients required major revision surgery.
Participants in both groups report regular upper gastrointestinal symptoms (GSRS: GT = 2.1, PR = 2.0) and were more symptomatic than the normal population (1.4) but not statistically different from each other. HRQoL (GIQLI = 113) was lower than after PR (122) but not significantly different (p = 0.29) and the normal population (125). 23% of GT participants had higher than normal HRQoL.
Conclusions
GT for EA is associated with significant morbidity and symptoms, including issues previously unreported in adulthood such as mental health problems. This mandates long term follow up and quality transition of these patients into adult care.
Type of study
Retrospective study.
Level of evidence
Level III.