Eleonora Sofie van Tuyll van Serooskerken, Gabriele Gallo, Bas L Weusten, Jessie Westerhof, Lodewijk Aa Brosens, Sander Zwaveling, Jetske Ruiterkamp, Jan Bf Hulscher, Hubertus Gm Arets, Arnold Jn Bittermann, David C van der Zee, Stefaan Haj Tytgat, Maud Ya Lindeboom
{"title":"成人胃上拉和空肠间置术治疗长间隙食管闭锁后的移植物扩张和Barrett食管。","authors":"Eleonora Sofie van Tuyll van Serooskerken, Gabriele Gallo, Bas L Weusten, Jessie Westerhof, Lodewijk Aa Brosens, Sander Zwaveling, Jetske Ruiterkamp, Jan Bf Hulscher, Hubertus Gm Arets, Arnold Jn Bittermann, David C van der Zee, Stefaan Haj Tytgat, Maud Ya Lindeboom","doi":"10.4253/wjge.v15.i9.553","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Esophageal replacement (ER) with gastric pull-up (GPU) or jejunal interposition (JI) used to be the standard treatment for long-gap esophageal atresia (LGEA). Changes of the ER grafts on a macro- and microscopic level however, are unknown.</p><p><strong>Aim: </strong>To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.</p><p><strong>Methods: </strong>A cohort study was conducted including all LGEA patients ≥ 16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands. Patients underwent clinical assessment, contrast study and endoscopy with biopsy. Data was collected prospectively. Group differences between JI and GPU patients, and associations between different outcome measures were assessed using the Fisher's exact test for bivariate variables and the Mann-Whitney <i>U</i>-test for continuous variables. Differences with a <i>P</i>-value < 0.05 were considered statistically significant.</p><p><strong>Results: </strong>Nine GPU patients and eleven JI patients were included. Median age at follow-up was 21.5 years and 24.4 years, respectively. Reflux was reported in six GPU patients (67%) <i>vs</i> four JI patients (36%) (<i>P</i> = 0.37). Dysphagia symptoms were reported in 64% of JI patients, compared to 22% of GPU patients (<i>P</i> = 0.09). Contrast studies showed dilatation of the jejunal graft in six patients (55%) and graft lengthening in four of these six patients. Endoscopy revealed columnar-lined esophagus in three GPU patients (33%) and intestinal metaplasia was histologically confirmed in two patients (22%). No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia. Three GPU patients (33%) experienced severe feeding problems <i>vs</i> none in the JI group. The median body mass index of JI patients was 20.9 kg/m<sup>2</sup> <i>vs</i> 19.5 kg/m<sup>2</sup> in GPU patients (<i>P</i> = 0.08).</p><p><strong>Conclusion: </strong>The majority of GPU patients had reflux and intestinal metaplasia in 22%. The majority of JI patients had dysphagia and a dilated graft. Follow-up after ER for LGEA is essential.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"15 9","pages":"553-563"},"PeriodicalIF":1.4000,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/c3/WJGE-15-553.PMC10514707.pdf","citationCount":"0","resultStr":"{\"title\":\"Graft dilatation and Barrett's esophagus in adults after gastric pull-up and jejunal interposition for long-gap esophageal atresia.\",\"authors\":\"Eleonora Sofie van Tuyll van Serooskerken, Gabriele Gallo, Bas L Weusten, Jessie Westerhof, Lodewijk Aa Brosens, Sander Zwaveling, Jetske Ruiterkamp, Jan Bf Hulscher, Hubertus Gm Arets, Arnold Jn Bittermann, David C van der Zee, Stefaan Haj Tytgat, Maud Ya Lindeboom\",\"doi\":\"10.4253/wjge.v15.i9.553\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Esophageal replacement (ER) with gastric pull-up (GPU) or jejunal interposition (JI) used to be the standard treatment for long-gap esophageal atresia (LGEA). Changes of the ER grafts on a macro- and microscopic level however, are unknown.</p><p><strong>Aim: </strong>To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.</p><p><strong>Methods: </strong>A cohort study was conducted including all LGEA patients ≥ 16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands. Patients underwent clinical assessment, contrast study and endoscopy with biopsy. Data was collected prospectively. Group differences between JI and GPU patients, and associations between different outcome measures were assessed using the Fisher's exact test for bivariate variables and the Mann-Whitney <i>U</i>-test for continuous variables. Differences with a <i>P</i>-value < 0.05 were considered statistically significant.</p><p><strong>Results: </strong>Nine GPU patients and eleven JI patients were included. Median age at follow-up was 21.5 years and 24.4 years, respectively. Reflux was reported in six GPU patients (67%) <i>vs</i> four JI patients (36%) (<i>P</i> = 0.37). Dysphagia symptoms were reported in 64% of JI patients, compared to 22% of GPU patients (<i>P</i> = 0.09). Contrast studies showed dilatation of the jejunal graft in six patients (55%) and graft lengthening in four of these six patients. Endoscopy revealed columnar-lined esophagus in three GPU patients (33%) and intestinal metaplasia was histologically confirmed in two patients (22%). No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia. Three GPU patients (33%) experienced severe feeding problems <i>vs</i> none in the JI group. The median body mass index of JI patients was 20.9 kg/m<sup>2</sup> <i>vs</i> 19.5 kg/m<sup>2</sup> in GPU patients (<i>P</i> = 0.08).</p><p><strong>Conclusion: </strong>The majority of GPU patients had reflux and intestinal metaplasia in 22%. The majority of JI patients had dysphagia and a dilated graft. Follow-up after ER for LGEA is essential.</p>\",\"PeriodicalId\":23953,\"journal\":{\"name\":\"World Journal of Gastrointestinal Endoscopy\",\"volume\":\"15 9\",\"pages\":\"553-563\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2023-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/c3/WJGE-15-553.PMC10514707.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Gastrointestinal Endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4253/wjge.v15.i9.553\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Gastrointestinal Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4253/wjge.v15.i9.553","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Graft dilatation and Barrett's esophagus in adults after gastric pull-up and jejunal interposition for long-gap esophageal atresia.
Background: Esophageal replacement (ER) with gastric pull-up (GPU) or jejunal interposition (JI) used to be the standard treatment for long-gap esophageal atresia (LGEA). Changes of the ER grafts on a macro- and microscopic level however, are unknown.
Aim: To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.
Methods: A cohort study was conducted including all LGEA patients ≥ 16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands. Patients underwent clinical assessment, contrast study and endoscopy with biopsy. Data was collected prospectively. Group differences between JI and GPU patients, and associations between different outcome measures were assessed using the Fisher's exact test for bivariate variables and the Mann-Whitney U-test for continuous variables. Differences with a P-value < 0.05 were considered statistically significant.
Results: Nine GPU patients and eleven JI patients were included. Median age at follow-up was 21.5 years and 24.4 years, respectively. Reflux was reported in six GPU patients (67%) vs four JI patients (36%) (P = 0.37). Dysphagia symptoms were reported in 64% of JI patients, compared to 22% of GPU patients (P = 0.09). Contrast studies showed dilatation of the jejunal graft in six patients (55%) and graft lengthening in four of these six patients. Endoscopy revealed columnar-lined esophagus in three GPU patients (33%) and intestinal metaplasia was histologically confirmed in two patients (22%). No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia. Three GPU patients (33%) experienced severe feeding problems vs none in the JI group. The median body mass index of JI patients was 20.9 kg/m2vs 19.5 kg/m2 in GPU patients (P = 0.08).
Conclusion: The majority of GPU patients had reflux and intestinal metaplasia in 22%. The majority of JI patients had dysphagia and a dilated graft. Follow-up after ER for LGEA is essential.
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