Abstract
Background: Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. Methods: Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. Results: The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score −2.68 ± 0.8 vs −0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents’ perceptions of the general health and emotional state of their babies (p < 0.001). Conclusions: The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.
Highlights
Introduction nal affiliationsLong-gap esophageal atresia (LGEA) occurs in 10% of patients with esophageal atresia [1,2], and represents a challenge for surgical issues, post-operative sequelae, and comorbidities.It is still universally accepted that preserving the native esophagus is the best option for the patient [3,4,5,6]
We report an exploratory evaluation on the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgical treatment of Gastro-esophageal reflux disease (GERD) in a case series of patients born with long-gap esophageal atresia (LGEA) with an intra-thoracic gastro-esophageal junction (GEJ) and growth failure with the need to improve their nutritional profile in anticipation of surgery
The TGJ was placed at a mean age of 8.6 ± 5.6 months
Summary
Introduction nal affiliationsLong-gap esophageal atresia (LGEA) occurs in 10% of patients with esophageal atresia [1,2], and represents a challenge for surgical issues, post-operative sequelae, and comorbidities.It is still universally accepted that preserving the native esophagus is the best option for the patient [3,4,5,6]. Long-gap esophageal atresia (LGEA) occurs in 10% of patients with esophageal atresia [1,2], and represents a challenge for surgical issues, post-operative sequelae, and comorbidities. Fundoplication is considered the most common major surgical procedure in patients with LGEA [1,7,8]. Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. Methods: Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. The procedure was uneventful and well-tolerated in all seven cases
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