Colon Interposition Research Articles

Thoracoscopic assisted colon interposition for long-gap esophageal atresia: a novel technique

The purpose of this work is to present preliminary results of a novel technique of thoracoscopically assisted colon interposition for esophageal replacement in long-gap esophageal atresia (LGEA). Management of LGEA remains a challenge. When primary repair is not possible, esophagocoloplasty is our first choice for esophageal replacement; we usually place the colon retrosternally, but we treated two patients with LGEA who had previously undergone a sternotomy. Therefore, we decided to place the graft via an intrathoracic route, but the passage of the colic graft into the thorax was performed video-assisted thoracoscopic. The follow-up of the two patients is now 4 years. They are both currently in good general conditions and their feeding behavior is comparable to the other infants of equal in age. We have not got any complications related to the technique, in particular any problems associated with the thoracoscopically assisted colonic replacement. We found that short-term survival was accomplished with apparently equivalent outcomes of thoracoscopically assisted colon interposition for LGEA.

14 Years' experience of esophageal replacement surgeries.

BackgroundEsophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes have been described in the literature, each with their specific advantages and disadvantages. We carried out this retrospective study to share our experience of esophageal replacement.MethodologyThis study was conducted at the department of pediatric surgery The Children’s Hospital and The Institute of Child Health, Lahore. The records of patients treated for esophageal replacement were reviewed. The patients under follow-up were called for clinical evaluation and assessed of long terms complications if any.ResultsA total of 93 patients with esophageal replacement were included in the study. Esophageal replacement was done with gastric transposition in 84 cases (90%), colon interposition in 7 cases (7.5%) including one case of redo colonic interposition, and jejunal interposition in 2 cases (2%). Routes of esophageal replacement were trans-hiatal in 71 (76%), retrosternal in 13 (14%), and trans-hiatal with thoracotomy in 9 (10%) patients. Postoperatively, all of the conduits maintained viability. Wound infection was seen in 10 (11%), wound dehiscence in 5 (5%), anastomotic leak in 9 (10%), anastomotic stenosis in 12 (13%), fistula formation in 4 (4%), aortic injury 1 (1%), dumping syndrome 8 (9%), reflux 18 (19%), dysphagia 15 (16%) and death occurred in 12 patients (13%).ConclusionThere are problems with esophageal replacement in developing countries. In this context, gastric conduit appeared as the best conduit for esophageal replacement, using the trans-hiatal route for replacement, in the authors’ experience.

Treatment protocol for secondary esophageal reconstruction using 'supercharged' colon interposition flaps.

Locoregional esophageal cancer is currently treated with induction chemoradiotherapy, followed by esophagectomy with reconstruction, using a gastric conduit. In cases of conduit failure, patients are temporized with a cervical esophagostomy and enteral nutrition until gastrointestinal continuity can be established. At our institution, we favor reconstruction, using a colon interposition with a 'supercharged' accessory vascular pedicle. Consequently, we sought to examine our technique and outcomes for esophageal reconstruction, using this approach. We performed a retrospective review of all patients who underwent esophagectomy at our center between 2008 and 2018. We identified those patients who had a failed gastric conduit and underwent secondary reconstruction. Patient demographics, perioperative details, and clinical outcomes were analyzed after our clinical care pathway was used to manage and prepare patients for a second major reconstructive surgery. Three hundred and eighty eight patients underwent esophagectomy and reconstruction with a gastric conduit. Seven patients (1.8%) suffered gastric conduit loss and underwent a secondary reconstruction using a colon interposition with a 'supercharged' vascular pedicle. Mean age was 70.1 (±7.3) years, and six patients were male. The transverse colon was used in four cases (57.1%), left colon in two cases (28.6%), and right colon in one case (14.3%). There were no deaths or loss of the colon interposition at follow-up. Three patients (42.9%) developed an anastomotic leak, which resolved with conservative management. All patients had resumption of oral intake within 30days. Utilizing a 'supercharging' technique for colon interposition may improve the perfusion to the organ and may decrease morbidity. Secondary reconstruction should occur when the patient's oncologic, physiologic, and psychosocial condition is optimized. Our outcomes and preoperative strategies may provide guidance for those centers treating this complicated patient population.

Reoperative surgery for colon conduit failure: a major challenge in esophageal reconstruction

Colon interposition is a second-line reconstructive option after esophagectomy for carcinoma, caustic or peptic lesions refractory to dilatation, perforation or trauma, and end-stage achalasia (1); in other instances, such as prior gastrectomy, necessity of concomitant gastrectomy for syncronous gastric tumors, extensive gastric damage from caustic ingestion, proximal squamous-cell carcinoma, or failures of previous gastric pull-up, the stomach may not be available as a first-choice conduit or an extra-long graft may be required to reach the hypopharynx (2). The most typical colon transplant is a long graft with an upper intrathoracic or neck anastomosis, and location of the anastomosis depends on the route of colon interposition. A retrosternal route and a cervical esophago-colic anastomosis is generally preferred in patients with “hostile” mediastinum from previous thoracotomy or radiotherapy, or as a second-stage “bypass” procedure following emergency esophagectomy or esophageal exclusion and diversion (3). Rarely, when the retrosternal route is not viable due to previous sternotomy, the colonic graft can primarily be placed antesternally through a subcutaneous tunnel.

Magnamosis for esophageal atresia is associated with anastomotic strictures requiring an increased number of dilatations

Background/PurposeMagnamosis is a novel technique which utilizes high power magnets to anastomose the esophageal ends in children with esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF), theoretically avoiding the need for thoracotomy. The objective of this study was to compare anastomotic stricture formation requiring dilatation after magnamosis versus after conventional anastomosis. MethodsOur center treated the first 3 cases of EA ± TEF with magnamosis in Canada. One was unsuccessful and excluded from our study. The number of postintervention dilatations was compared to controls from our database, which includes all children with EA ± TEF treated between 1991 and 2015. The controls had EA ± TEF treated with pouch-to-end anastomosis or colonic interposition (n = 65). Mann–Whitney U tests were used with p < 0.05 being significant. ResultsThe 2 magnamosis cases had a mean of 13.5 dilatations, compared to 2.6 for the controls. Those managed with pouch-to-end anastomosis or colonic interposition had a mean of 2.3 and 2.7 dilatations, respectively. We found that the cases required more dilatations than controls (p = 0.022) and pouch-to-end anastomosis (p = 0.021), but not than colonic interposition (p = 0.106). ConclusionOur results indicate that magnamosis is associated with more postintervention dilatations than conventional anastomotic techniques, suggesting that magnamosis results in more frequent and/or more resilient anastomotic strictures. Level of evidence3

Enhancement of Colonic Absorptive Function after the Massive Resection of the Small Intestine Based on the Creation of an Artificial Colonic Valve

The colon can have an absorptive function similar to that of the small intestine after the massive resection of the small bowel. To improve colonic absorptive function, we created a valve in the colon (artificial colonic valve, ACV). ACVs were created in 20 rats that had 80 percent of their small intestine resected, with an observation time of 30 weeks. The ACV rats were compared with those in the non-operated control group, the short bowel syndrome (SBS) group and the colon interposition (CI) group. The ACV rats were much heavier than those in the control group, SBS group and CI group. In terms of histology and the levels of α-amylase and the Na+-dependent bile salt transporter, the absorptive function of the colons before the valves resembled that of the small intestine. The colonic absorptive function was more obvious in ACV rats than in CI rats. An ACV can enhance colonic absorptive function after the massive resection of the small intestine. The colonic absorptive function of ACV rats was better than that of the rats in the CI group.

The Effectiveness of Laparoscopic-assisted Percutaneous Endoscopic Gastrostomy in Patients with Unfavorable Anatomy: A Single-center Retrospective Cohort Study.

Percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patients unable to maintain adequate nutrition via the oral route. In patients with morbid obesity, altered intra-abdominal anatomy due to prior abdominal surgery, the interposition of the colon or other factors precluding endoscopy, feeding tube placement by laparoscopic means (LAPEG) can provide a potentially safe alternative. The objective of this study was to examine the efficacy and outcomes of laparoscopic-assisted placement of PEG in adult patients. This is a retrospective cohort analysis of adult patients, who underwent PEG and/or laparoscopic-assisted percutaneous endoscopic gastrostomy placement (LAPEG) by two surgeons at a single institution. A total of 36 patients underwent PEG and/or LAPEG. No significant differences were found in the total and postoperative length of stay and mortality. There were no procedure-related complications in the LAPEG group versus two in the PEG group (8.7%), but this did not reach statistical significance. LAPEG was 100% successful in gaining enteral feeding access in patients that had failed PEG. The most common reason for PEG placement failure was colonic interposition (39%), followed by intra-abdominal adhesions and gastric displacement by hiatal hernia (each 23%). 38.5% of LAPG procedures could be done via 5-mm single port access, 38.5% required two-port and 23% required three-port access. In conclusion, LAPEG is a feasible minimally invasive alternative to gain enteral feeding access in patients that have failed PEG that does not increase the length of stay, morbidity or mortality.

Transhiatal isoperistaltic colon interposition without cervical oesophagostomy in long-gap oesophageal atresia.

Background:Oesophageal colonic interposition in oesophageal atresia (OA) patients is almost exclusively done as a staged operation with an initial oesophagostomy and gastrostomy followed by the definitive surgery months later. This study presents a series of patients in whom a cervical oesophagostomy was not performed before the substitution surgery.Patients and Methods:Records of EA patients were evaluated for those who underwent colon interposition without cervical oesophagostomy.Results:There were five patients: three with pure EA and two with proximal tracheo-oesophageal fistula. A delayed primary repair could not be performed because of intra-abdominally located distal pouch. The mean age at the time of definitive operation was 5.54 (±2.7) months and the mean weight was 6.24 (±1.3) kg. A right or a left colonic segment was used for interposition keeping the proximal anastomosis within the thorax. The post-operative results were quite satisfactory within a median follow-up period of 33.2 months.Conclusion:Avoiding cervical oesophagostomy and its inherent complications and drawbacks is possible in a subset of patients with long-gap EA who underwent colonic substitution surgery. This approach may be seen as an extension of the consensus that the native oesophagus should be preserved whenever possible, because it uses the native oesophagus in its entirety.

Surgical treatment of acquired tracheoesophageal fistula caused by balloon dilatation of corrosive esophageal stricture in a child

Introduction. Tracheoesophageal fistula (TEF) as a complication of balloon dilatation (BD) of corrosive esophageal stricture is a very rare and serious condition. Life threatening aspiration pneumonia requests urgent lungs' protection, but overall treatment strategy is not clearly defined. Case report. Twenty-month-old female child accidentally ingested a household bleach. Caustic injury of esophagus was healing with development of strictures of cervical and proximal thoracic esophagus. TEF was developed during the third BD. Healing of TEF and pulmonary infection was achieved by exclusion of the esophagus (pharyngostoma and feeding gastrostomy together) with prolonged tracheobronchial intubation and toilette. Retrosternal colon interposition was performed a year later, with excellent functional results over four-year follow-up. Conclusion. Esophageal exclusion in the first stage, and pharyngoesophageal reconstruction in the second stage, is a useful therapeutic option in the treatment of TEF caused by balloon dilatation of corrosive esophageal stricture in children.

Frequency of Polyps and Adenocarcinoma in Colon Interposition After Esophagectomy in Adulthood - A Systematic Review.

Colon interposition counts among the most common techniques for reconstruction after esophagectomy. Availability of data on metachronous mucosal pathologies is weak. The aim of this review was to identify all reports on the development of metachronous adenoma and adenocarcinoma in colon interposition after esophagectomy in adulthood. A comprehensive search was conducted in MEDLINE/PubMed, Science Direct, Cochrane Library, Bayerische Staatsbibliothek München. All studies reporting on patients who received colon interposition as substitute after esophagectomy in adulthood for benign and malignant reasons were included. Five retrospective studies were included, reporting on 1016 patients. Therein, no interval lesion was identified. One further study, which formally must be excluded for a misfit to inclusion criteria reports on three interval carcinomas within 365 patients. Because these lesions were the only ones found within a cohort analysis, results were supplementary reported in this review. Additionally, 31 case reports including 32 patients with benign (n=7) or malignant (n=25) findings were analyzed. Median age was 63.5 years (interval carcinoma) and 69 years (benign lesion). Benign and malignant lesions were diagnosed after a median of 8.5 years. Due to the rareness of respective cohort studies, the frequency of metachronous lesions cannot be calculated accurately. The estimated rate of interval carcinoma is 0-0.22%. Life-long endoscopic surveillance of patients with colon interposition is recommended.

P61 CARDIAC TAMPONADE - A SERIOUS COMPLICATION AFTER COLON CONDUIT INTERPOSITION: A CASE REPORT

Abstract Aim Graft redundancy and anastomotic stricture after colon interposition are well-known late complications. Cardiac compression by distended colon conduit is uncommon. There is a few reports in the literature. We present a case of 58-year-old patient with a major dilatation of colon conduit occurred 7 years after esophagectomy and gastrectomy. Case report The patient was admitted to district general hospital with 4-hour history of abdominal pain. Chest X- ray and abdominal computer tomography (CT) scan revealed distended colon conduit, pneumomediastinum, small-bowel ileus and pneumoretroperitoneum. An attempt to insert a nasogastric tube failed and an emergency laparotomy was performed. At operation, a band causing small bowel strangulation and adhesions were divided. The bowel appeared viable and a clear perforation was not found. Resection was not necessery. For next 10 hours, progressing hemodynamic instability and sepsis required intravenous vasoactive medication and orotracheal intubation. Chest CT scan showed massive distention of substernal colon conduit with compression of heart and pulmonary arteries. The patient was referred to our institution. Prompt endoscopy was performed with suction of air and liquid content from colon and nasogastric tube was inserted. The colonic mucosa was viable without necrosis and perforation. Hemodynamics improved immediately after decompression of colonic roll. An exploratory laparotomy revealed fatal extensive ischemia infarction of the bowel and the patient died within 4 hours after surgery. Concluson Extrapericardial cardiac tamponade is a rare complication after substernal esophageal reconstruction and could lead to bowel hypoperfusion or ischemia. Early recognition of symptoms and management with conduit decompression are important.

P167 MINIMALLY-INVASIVE 3-STAGE ESOPHAGECTOMY FOR CANCER WITH COLONIC INTERPOSITION: THE INITIAL EXPERIENCE IN A TERTIARY CENTER

Abstract Aim First choice for restoration of the gastrointestinal tract after esophagectomy is gastric conduit, however when stomach is unavailable as in history of gastrectomy, concurrent gastric disease or gastric cancer, colon or subsequently jejenum can be used as an esophageal substitute. The aim of this study is to discuss safety, technique and feasibility of colonic interposition, in the era of minimally invasive surgery in a tertiary esophageal centre. Background &amp; Methods From 01/09/2018 to 01/06/19, two patients with esophageal cancer underwent Hybrid 3-stage esophagectomy, using the left colon as an esophageal conduit, in our department. Both patients were objected to thoracoscopic esophageal mobilization, in prone position. The patients were then turned to supine position and laparotomy was performed. Colonic conduit was prepared, transferred to the left neck in a posterior mediastinal position and a handsewn oesophagocolonic anastomosis was performed. Clinicopathological outcomes were studied. Results Mean operative time was 420 minutes and mean blood loss was 160cc. No intraoperative complications were reported. The mean time of Intensive care unit stay of our patients was 6 days and mean duration of hospital stay was 25 days. Postoperative complications observed was 1 contralateral pneumothorax and 1 ipsilateral pneumonia. R0 resection was achieved in both patients. Mean lymph nodes harvested were 45. Both patients were discharged in good clinical condition. Conclusion Hybrid 3-stage esophagectomy with colonic interposition may be a safe and feasible technique when performed in an experienced Upper Gastrointestinal Surgical Department Unit.

O100 WORLDWIDE TECHNIQUES AND OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): RESULTS FROM THE INTERNATIONAL UGIRA REGISTRY

Abstract Aim The aim of this study was to gain insight in the techniques and outcomes of RAMIE worldwide. Background &amp; Methods Although robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted. The current literature on RAMIE mainly consists of single-center case series with considerable variation in reported techniques and outcomes. To gain an overview of the worldwide practice in RAMIE, an online registry was established by the Upper GI International Robotic Association (UGIRA). The collected data involve patient- and treatment characteristics, as well as postoperative outcomes that include complications as defined by the Esophageal Complications Consensus Group, length of stay, re-admissions (i.e. &lt;30 days after discharge), mortality (i.e. in-hospital or &lt;30 days after surgery), and pathological results. The outcomes were descriptively analyzed for this interim report. Results A total of 434 patients who underwent RAMIE for esophageal cancer between 2016-2019 were included in this interim analysis. The mean age was 63 years (SD ±9.7), the majority was male (n=359, 83%), and nearly all patients had an ASA score ≥2 (n=398, 92%). Adenocarcinoma (n=253, 58%) and squamous cell carcinoma (n=162, 37%) were most prevalent. The usual surgical approach was transthoracic (n=428, 99%) with the patient in semiprone position (n=393, 91%). Gastric conduit reconstruction was performed in all except one patient, who received a colonic interposition. The anastomosis was created by hand-sewing (n=207, 48%), circular stapling (n=142, 32%), or linear stapling (n=85, 20%). The median intraoperative blood loss was 120 milliliters (IQR 70-280) and the median operating time was 392 minutes (IQR 353-455). Postoperative complications occurred in 251 patients (59%) and mainly involved pulmonary complications (n=138, 32%), anastomotic leakage (n=80, 18%), and cardiac complications (n=55, 13%). Mortality occurred in 9 patients (2%) and re-admission because of complications was required in 57 patients (14%). A median of 28 lymph nodes (IQR 21-35) were removed and a radical resection was achieved in 400 patients (92%). Conclusion The presented results are the first to provide an overview of the techniques that are commonly used in RAMIE. By demonstrating results that are in line with recent benchmarking literature, this study demonstrates the safety and feasibility of RAMIE.

O212 IVOR LEWIS ESOPHAGECTOMY AFTER SLEEVE GASTRECTOMY: THE USE OF GASTRIC CONDUIT IS STILL POSSIBLE

O212 IVOR LEWIS ESOPHAGECTOMY AFTER SLEEVE GASTRECTOMY: THE USE OF GASTRIC CONDUIT IS STILL POSSIBLE

RETROSPECTIVE AND PROSPECTIVE STUDY OF CORROSIVE POISONING AND ITS EFFECT ON UPPER GASTRO INTESTINAL TRACT AND SURGICAL MANAGEMENT IN TERTIARY CARE CENTRE

Background: Corrosive injury to the upper gastrointestinal tract is an insufferable experience for both the patient and surgeon. Corrosive ingestion may usually responsible for wide spread injury to the lips, oral cavity, oropharynx and the upper air way, upper gastrointestinal tract.&#x0D; Results: in our study more common patients were in the age group 21-30 years. Majority of the patients had consumed toilet cleaner. Majority of the patients had consumed substance of &lt;=30 ml. Majority of the patients had consumed HCL. Majority of the patients had consumed the substance with a suicidal Intention, [ 42.9%] consumed corrosive under influence of alcohol, In 5 (14.3%) patients had oropharynx involvement, in 8 (22.9%) patients had lower esophagus involvement, in 8 (22.9%) patients had middle esophagus involvement and 17 (48.6%) patients had upper esophagus involvement. In 18 (51.4%) patients had pylorus (stomach) involvement and in 5 (14.3%) patients duodenum (first part) involvement. In 11 (31.4%) patients esophagus was involved at 2A level, in 17 (48.6%) patients esophagus was involved at 2B level and in 2 (5.7%) patients esophagus was involved at 3A level. In 9 (26.5%) patients dilatation was not possible, in 2 (5.9%) patients it was not done. In 9 (26.5%) dilatation was done 2 times and in 14 (41.1%) patients dilatation was done 3 times .In 34 (97.1%) patients feeding jejunostomy insertion was done in 1 (2.9%),most common sequels esophageal stricture [65.7%] and GOO[40%], patient laparotomy Bilroth II gastrectomy was done as a primary intervention. Majority of the patients complained of dysphagia and chest pain and cough at first visit. In 11 (32.4%) patients gastrojejunostomy was done, in 7 (20.6%) patients esophagectomy with gastric pull-up was done, in 4 (11.8%) patient’s thoracoscopic esophagectomy with colonic interposition was done. There were 3 (8.6%) deaths and 32 (91.4%) patients were discharged successfully in our study there was a significant improvement seen in the weight from follow-up at 2 months till the end of follow-up at 12 months (p&lt;0.05).&#x0D; Conclusion: In our study corrosive ingestion common in young age decrees, with increase age, (HCL) toilet cleaner found to be the commonest corrosive chemical used esophags most common than pylorus affected by the ingestion, oropharynx and duodenum less likely,2Bgrade of injury was affected the most in esophagus, stomach or duodenum, with a very high incidence of stricture formation. Dysphagia, throatpain, excessive salivation and hoarseness of voice were the commonest presenting symptoms. The first line of performed surgery at presentation was insertion of feeding jejunostomy and improvement in diet intake and strength of feeding jejunotomy patients underwent gastrojejunostomy, esophagectomy with gastric pull-up or thoracoscopic esophagectomy with colonic interposition. Dilatation was required in majority of the patients. There was a significant improvement in the weight of these patients over various follow-up periods. The overall success rate of management of these patients was found to be very high with only a very few deaths recorded in our study.&#x0D; Keywords: Corrosive injury, Esophagealstricture, Gastric outlet obstruction, Upper GI endoscopy.

PROSPECTIVE AND RETROSPECTIVE STUDY OF COLONIC INTERPOSITION IN BENIGN AND MALIGNANT ESOPHAGEAL LESION.

The Retrospective and prospective study entitled "Prospective and Retrospective study of Colonic Interposition in Benign and Malignant Esophageal Lesion" will be conducted in the Department of Surgery of MGM Medical College and M.Y. Hospital, Indore over a period of 2 year.&#x0D; The above table shows the distribution of patients according to presenting complains. 1 (3.3%) patient presented with liquid dysphagia, 23 (76.7%) patients presented with solid and liquid dysphagia and 6 (20.0%) patients presented with solid dysphagia. Majority of the patients had solid and liquid dysphagia. the distribution of patients according to diagnosis. 6 (20.0%) patients had carcinoma esophagus and 24 (80.0%) patients had esophageal strictures. Majority of the patients had esophageal strictures. Comparison of wound site infection. At 2 weeks, 2 (6.7%) patients had wound site infection, which was still present at 1 month and decreased to 1 (3.3%) at 3 months. After 3 months, none of the patients had wound site infection.&#x0D; The colon interposition is an alternative option for esophageal reconstruction when the stomach is unavailable the quality of life after colonic transposition compared at postoperative 1 month and 2 year using specially designed QOL questionnaire for coloplasty patients. Our disease specific questionnaire performs well in relation to previously published study which was used same questionnaire asses the quality of life. in post coloplasty patients According to the selected colon graft (left or Right) route of reconstruction, direction of graft various surgical procedures can be considered for colonic reconstruction in present study left colic artery based left colonic graft is used. Regardless of the situation, blood supply of colon graft directly affect the outcome of the surgery.&#x0D; Keywords: Colonic, Interposition, Esophageal &amp; Lesion.

Retraction Note: Failed Gastric Pull up after Esophagectomy Managed by Colonic Interposition

The Editor-in-Chief is retracting this article [1] because the authors have not been able to provide documentary evidence that they obtained consent to publish from the patient whose details are described in this case report

1800 Tubular Adenoma With High Grade Dysplasia in the Esophagus: It Can Happen!

INTRODUCTION: Tubular adenoma is a common finding in the colon accounting for majority of the colonic adenomas. Consensus guidelines have outlined surveillance intervals for patients with tubular adenoma in the colon based on the number and size. We present a unique case of a tubular adenoma in the interpositioned colon. Colonic interposition is a common surgery in patients with esophageal atresia. We present a unique case of a TA with high-grade dysplasia in the interpositioned colon. CASE DESCRIPTION/METHODS: A 50-year-old female with a past history of esophageal atresia who underwent colonic interposition between the upper esophagus and stomach at the age of five presented with dysphagia. A barium swallow was performed which showed delayed emptying in the mid-esophagus. An esophagogastroduodenoscopy (EGD) was performed which showed food material stuck in the proximal interpositioned colon. There were no strictures at the site of the anastomosis. Incidentally a 10 mm polypoid lesion was seen in the interpositioned segment of the colon [Figure 1]. The polypoid lesion was biopsied and histological examination showed disorganized glands in the background of normal colonic mucosa along with hyperchromatic nuclei with increased mitosis in the cells, consistent with tubular adenoma. Repeat EGD showed three sessile polyps ranging from 10 mm to 20 mm in size. The polyps were successfully resected using hot snare polypectomy. Pathological examination showed two tubular adenomas, and the largest polyp had tubular adenoma with focal high grade dysplasia [Figure 2]. Resection margins were negative for dysplasia. A colonoscopy was also performed which found two sub-centimeter adenomatous polyps as well. DISCUSSION: Esophageal atresia is a congenital malformation of the upper gastrointestinal tract. The prevalence varies from 1 in 2500 to 1 in 4500 births. Currently, there is no ideal replacement for the esophagus. Primary anastomosis of the esophagus is performed in about 90% of cases, and a colonic interposition is performed when there is an extremely long gap. Common complications with colonic interposition include stenosis of the anastomosis, esophageal dysmotility, and gastroesophageal reflux. Development of adenomatous polyps in the interpositioned segment of the colon are exceedingly rare and usually an incidental finding. Our case and other similar reports highlight that surveillance strategies need to be developed in these patients to prevent carcinoma.

1742 A Rare Case of Colorectal Cancer of the Neoesophagus

INTRODUCTION: In the case that follows, we present a case and literature review of oligometastatic intestinal adenocarcinoma originating in a colonic interposition repair of esophageal atresia. Uniquely, the pathology of the tumor was consistent with colonic mucosa which only a few such instances have been reported in literature. CASE DESCRIPTION/METHODS: A 58-year-old female with a past medical history of tetralogy of Fallot (repaired at age 14), esophageal atresia status post esophageal colonic interposition, esophageal and pyloric stenosis, neo-esophageal polyp (found 2 years prior with biopsy showing reactive epithelial atypia), and atrial fibrillation on Coumadin presented to the hospital complaining of fatigue and dyspnea of one week duration. Her family history was significant for colon cancer in her father. Initial lab workup revealed a hemoglobin of 5. She was transfused 3 units of packed red blood cells. Due to severe symptomatic anemia, an upper endoscopy and colonoscopy were performed revealing an ulcerated mass, approximately 50% in circumference in the lower third of the esophagus, as well as moderate pyloric stenosis that prevented passage of the endoscope. The esophageal masswas not amenable to endoscopic excision due to undulations of the cardiac beat, however biopsy demonstrated invasive, moderately differentiated, intestinal-type adenocarcinoma (Figure 1). Given these findings a PET/CT scan was obtained which revealed a 2cm mass in the distal aspect of the interposed colonic segment and a 1.7 × 1.2cm hypodense mass in the medial segment of the left hepatic lobe, consistent with metastasis. She was referred to Cardiothoracic Surgery for tumor resection and Oncology for neoadjuvent chemotherapy. DISCUSSION: Oligiometastatic colorectal cancer or the esophagus is an extremely rare medical condition. Our patient had an initial polyp removed in 2016, that was read as reactive epithelial atypia. More diligent surveillance was likely warranted for her case. This was shown by Lindahl et al in long-term endoscopic follow-ups in patients with this condition. Of the 12 patients observed in the study, a variety of colonic pathology was foundranging from dysplasia, colonic polyp, and aneuploid cells. Given these findings, albeit rare, with one case report citing less than 15 instances, special considerations should be made for close surveillance of these patients. Although no specific treatment guidelines exist for this anomaly, there has been documented success with a curative resection.

Free jejunal flap esophagoplasty for ischemic colon conduit replacement

Colon interposition is mainly used as a second-line treatment, when the stomach has to be resected, or when the stomach is deliberately kept intact for benign diseases in patients with long-life expectancy. Colon provides extended conduit length, reliable blood supply and low incidence of reflux. However, the early and late postoperative ischemic complication rate is 5–15%. The most serious but rare complication is the acute conduit necrosis. More severe cases of necrosis require conduit take down with proximal esophageal diversion and placement of an enteral feeding tube. Reconstruction can be planned for later if possible. An uncommon complication is the colonic stricture due to chronic ischemia, which can be treated with conservative methods such as dilation and stenting. Surgery may be indicated since the impaired deglutition can compromise the quality of life. Supercharged or free jejunal interposition is a suitable alternative conduit for esophageal replacement in patients with otherwise limited delayed reconstructive options. Good functional outcomes can be achieved despite the formidable technical challenges in this group of patients. In three such cases, we could successfully use a free jejunal flap for reconstruction; in two cases after colon conduit necrosis and in one case due to a late ischemic stricture. In each case the replacement type was different, using substernal, presternal and sternotomy routes. The arterial blood supply was provided by the internal mammary artery. Saphenous graft was used to interconnect to external jugular or innominate vein to reestablish the venous drainage. All three patients survived without further complications.