J.Jpn. Surg. Soc.. 110(4): 179-183, 2009

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Feature topic

LONG-TERM COMPLICATIONS OF ESOPHAGEAL ATRESIA

Esophageal atresia (EA) is a rather common neonatal anomaly frequently associated with other congenital anomalies such as cardiac, genitourinary, and anorectal malformations and chromosomal disorders. It is suggested that the abnormal pattern of expression of the gene Sonic hedgehog is associated with failure of tracheoesophageal separation resulting in EA in an animal model. EA with distal tracheoesophageal fistula (TEF) is the most common type of EA and is usually treated successfully with division of the TEF and primary anastomosis. However, the optimal surgical treatment for long-gap EA remains controversial. Even though the results of delayed anastomosis with the Lividitis method or Collis-Nissen method are mainly reported to be satisfactory, long-term results show a high incidence of gastroesophageal reflux (GER) and esophageal dysmotility. Replacement with the gastric tube, stomach, colon, or jejunum has been performed when the gap is too long to use the native esophagus. Anastomotic stricture, obstruction due to redundancy, and adhesion of substitutes were reported in long-term follow-up studies. Moreover, the risk of carcinogenesis in Barrett's metaplasia, which is associated with GER, must be taken into consideration. Thus, long-term follow-up into adulthood is warranted in patients with EA.

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