The Effect of Traction on Esophageal Structure in Children with Long-Gap Esophageal Atresia

Abstract

We examined the esophageal structure in children who underwent traction to achieve primary repair of longgap esophageal atresia. High-resolution ultrasound was used to compare thickness of the proximal and distal esophagus in children who had traction to achieve primary repair (n = 15) to cases of esophageal atresia with shorter gaps that did not require traction (n = 8). The muscularis propria of the upper esophagus was thicker in the traction compared to the non-traction group, though not statistically significant (respectively, 0.79 (0.18) mm vs. 0.71 (0.16) mm; p = 0.29), measurements were similar for the lower esophagus (respectively, 0.79 (0.21) mm vs. 0.75 (0.13) mm; p = 0.64). Combined mucosa and submucosa was very similar in both groups for the upper (respectively, 1.03 (0.15) mm vs. 1.04 (0.16) mm; p = 0.95) and lower esophagus (respectively, 1.09 (0.23) mm vs. 1.01 (0.13) mm; p = 0.37). The thickness of individual mural layers is maintained after increasing esophageal length with traction.

Update on Foregut Molecular Embryology and Role of Regenerative Medicine Therapies

“…In other cases, either jejunum or colon is used as substitute, with sections of these organs moved together with their own vasculature (6–8). More recently, closure of the gap by mechanical lengthening via external traction has been attempted by several surgeons (10–12), with Khan et al reporting preservation, in terms of thickness, of the mural layers of the esophagus after this treatment (13). …”

Esophageal stenting in children: indications, application, effectiveness, and complications

“…At the University of Minnesota, tension is applied to the esophageal ends in order to elicit esophageal growth, thereby circumventing the need for esophageal replacement in cases of long-gap esophageal atresia. 11,12 Although this approach has been very successful, 13 resistant anastomotic strictures that required multiple dilations or resection occurred in about 15% of patients. Because of the potential risks in dilation, 14,15 we thought a retrievable stent might provide a better solution than simple dilations and, therefore, developed this approach.…”

Histological study of the elongated esophagus in a rat model

“…Khan et al. (9) reported that the thicknesses of individual mural layers were maintained after the esophageal length was increased with traction in EA patients after suture. Intestinal smooth muscle hypertrophy was seen with mechanical stimulation in an animal model, and the cell proliferation was increased by mechanical stimulation.…”

“…It has been shown to elongate the esophageal length, allowing for direct esophageal anastomosis, and it can be carried out in a clinical setting for EA patients (1). Khan et al (9), using high-resolution ultrasound, reported that there was no significant difference in the thickness of the individual mural layer between a traction group and a non-traction group of EA patients after the use of traction suture.…”