Managing the Complex Esophagus

Abstract

Complex esophageal problems in children are uncommon and mainly include long-gap esophageal atresia, injuries due to caustic ingestion, and failed attempts at repair of congenital esophageal abnormalities. These complex problems require detailed investigation with imaging and endoscopy before decisions about surgical management can be made. The aim of treatment is to salvage the native esophagus and optimize esophageal function. If salvage is not achieved, esophageal replacement is considered. The two most commonly used replacement techniques are gastric transposition and colonic interposition. The evidence for which technique is superior remains equivocal, but we favor gastric transposition. Preclinical studies suggest tissue engineering may be useful for esophageal replacement in the future. Care of the pediatric patient with complex esophageal disease should be centralized in experienced centers with experienced surgeons.

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