Esophageal Injuries and Replacement

Abstract

Caustic ingestion of strong acid or alkaline substances is the most common cause of esophageal injury in the pediatric population. This injury can result in significant long-term sequelae, limiting patient function and overall well-being. The clinical manifestations of caustic ingestion are dependent on the type and amount of agent ingested as well as the timing of the ingestion. Symptoms do not accurately correlate with the degree of esophageal injury. Timely diagnosis and examination of extent of injury must be performed with esophagoscopy. Although many modalities exist for treatment of esophageal injury, the use of native esophagus is believed to be superior in instances where primary anastomosis may be achieved. In severe and complex cases, esophageal replacement must be pursued. Several options exist for esophageal replacement. These include gastric transposition, gastric tube, colon interposition, and jejunal interposition. Each of these modalities has specific benefits with regard to functional outcome and procedural technical characteristics. However, complications are a concern, including anastomotic strictures, leak, gastroesophageal reflux, and necrosis. With the recent development of tissue-engineered organs and organoids, esophageal replacement with native engineered esophagus might be attainable in the future.