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Prolonged enteral feeding is often required to avoid long-term nutritional and metabolic complications after

Chrystèle Madre1, Lydia Serhal, Laurent Michaud

  • 1Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Hôpital Robert Debré, Paris, France.

Journal of Pediatric Gastroenterology and Nutrition
|August 12, 2009
PubMed

Insights

Total esophagogastric dissociation (TED) effectively treats GERD but can lead to significant nutritional and metabolic issues. Long-term monitoring and prolonged enteral nutrition are crucial for children undergoing this procedure.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Nutritional Science

Background:

  • Total esophagogastric dissociation (TED) is a surgical procedure initially for severe GERD in neurologically impaired children.
  • TED is increasingly used for other conditions like esophageal atresia and caustic esophageal injuries.
  • Long-term nutritional and metabolic outcomes of TED have not been previously documented.

Purpose of the Study:

  • To investigate the long-term nutritional and metabolic status of children undergoing TED without neurological impairment.
  • To assess growth, blood vitamin and iron levels, lipid malabsorption, and hyperglycemia after TED.
  • To evaluate the incidence of complications such as dumping syndrome and malabsorption.

Main Methods:

  • Prospective study of children without neurological impairment who underwent TED between 1999 and 2004.
  • Detailed assessment of metabolic and nutritional status, including blood tests for iron and vitamins A, D, E, B12.
  • Evaluation of lipid malabsorption, hyperglycemia, and growth parameters.

Main Results:

  • Seventeen children underwent TED, with a mean follow-up of 6 years; 12% mortality.
  • Seven children were weaned from enteral nutrition, but 5 experienced failure to thrive, steatorrhea, or vitamin malabsorption.
  • Dumping syndrome occurred in 8 patients, symptomatic in 6.

Conclusions:

  • TED is effective for GERD treatment but frequently causes nutritional and metabolic complications.
  • Dumping syndrome and chronic digestive malabsorption are significant concerns post-TED, particularly after enteral nutrition weaning.
  • Long-term follow-up and prolonged enteral nutrition support are recommended for patients after TED.
Abstract

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