Esophageal Atresia Treatment Program

Traditional treatments

Historically, surgeons have opted for one of the treatments below as a work-around to esophageal gaps. Each has unique advantages and disadvantages. Not every treatment is feasible for every child: differences in the length of the gap, for example, may render one approach more preferable than others.

Treatment	Description	Advantages	Disadvantages
G-tube	A tube is placed through the abdominal wall into the stomach, allowing for the direct delivery of nutrition	convenient mechanism for the regular introduction of nutrition allows venting of the stomach's gases	the g-tube can slip out of place, making maintenance and hygiene a challenge bowel obstructions can occur requires surgical revision over time potential social stigma
Spit fistula	Surgeons connect the upper esophagus to the skin, called a spit fistula, to drain the upper esophageal pouch via a small stoma in the neck. Children are then able to take small amounts of food orally, although nutrition for the body must be delivered with a G-tube.	minimal risk of aspiration allows the chewing and tasting of solid food little or no oral aversion to overcome easy to perform surgically	risk of injury to the nearby laryngeal nerve no nutrition by mouth drainage of saliva and chewed foods on to the neck can be messy and difficult to manage the stoma needs to be dilated as the child grows
Gastric pull-up	Stomach is repositioned and attached directly to the throat	stomach is a resilient organ and thus not truamatized or devascularized by the repositioning technically very feasible to perform allows eating by mouth	risks of acid reflux are intesified given the proximity of the stomach's opening to the top of the trachea poses risks of chronic aspiration and recurrent pneumonia, causing lung disease crowding in the upper chest decreases functional lung volume (ie. the space in which lungs can inflate and deflate) although the operation is technically straighforward, it is still a very invasive procedure requiring an abdominal operation chronic malnutrition, dumping syndrome (ie. diarrhea and low blood sugar if food is eaten too fast) chronic anemia
Colonic interposition [Click here to see X-ray]	Surgeons may move a section of colon from its place in the gut to the space left by the esophageal gap, in effect creating a replacement esophagus.	mimics the normal continuity and anatomy of mouth to conduit to stomach plenty of colon available in the body surgically, a straightforward procedure	individual segments of the transposed colon do not contract progressively to push food along (a process called peristalsis) the transposed colon grows faster than the child crowds the upper chest and puts pressure on the lungs multiple revision operations required, each one posing a risk to the blood supply and thus viability of the transposed colon risks of aspiration, pneumonia malnutrition halitosis
Jejunum interposition	Rather than a piece of colon, surgeons may use a section of the jejunum (the middle part of the small intestine) as a replacement esophagus.	jejunum is thin enough to be placed behind the trachea, mimicking the course of an esophagus jejunum does not dilate or "kink" in the manner of a transposed colon segment, so no surgical revisions are required jejunum undergoes peristalsis, helping push food toward the stomach	risk of ulceration to the transposed jejunum technically a very difficult operation to perform