Prolonged Enteral Feeding Is Often Required to Avoid Long‐term Nutritional and Metabolic Complications After Esophagogastric Dissociation

Abstract

TED is an effective procedure for treatment of GERD. However, nutritional and metabolic complications including dumping syndrome and chronic digestive malabsorption are frequent after TED, especially after enteral nutrition weaning. A long-term follow-up of these patients is thus necessary and prolonged enteral nutrition support is recommended.

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

“…Nutritional and metabolic complications including dumping syndrome and chronic digestive malabsorption (i.e. Vitamin B12) are frequent after TED, requiring prolonged enteral nutrition (281).…”

Total Esophagogastric and Cologastric Dissociation in Neurologically Normal Children: Systematic Review

“…The study reviewed 50 neurologically normal children, between 15 days of age, who had undergone esophagogastric or cologastric dissociation for According to Clavien-Dindo classification, one grade I and no grade II complications were reported in papers screened. Two children (4.1%) had early complications (Grade IIIb) and required reoperation for peritonitis and evisceration 4 and 10 days after TEGD [3].…”

“…Gastroesophageal reflux disease (GERD) is a common condition, defined by the passage of gastric contents into the esophagus causing troublesome symptoms and/or complications, affecting up to 3.3% of the pediatric population [ 1 ]. Its incidence is widely variable, reaching >77% in level IV–V neurologically impaired (NI) children (GMFCS-E&R) [ 2 , 3 ]. Respiratory complications are common and aspiration pneumonia is a leading cause of death in this group [ 4 ].…”

Jejunostomy Enteral Feeding in Children

“…However, fundoplication is associated with significant morbidity, especially in patients with NI and esophageal disorders 4 , 7 – 9 . Other options to stop acid reflux include TED 10 – 12 and different kinds of jejunostomy surgery 15 – 20 …”

“…However, there is a significant risk of complications and failure, especially in patients with significant comorbidity, such as patients with neurological impairment (NI) 6 – 9 . Recently, total esophagogastric dissociation (TED) has been proposed as a surgical approach in patients with severe GERD when normal enteral feeding is unfeasible 10 – 12 …”