Fate of the distal esophageal remnant following esophageal replacement

When a colon segment is used for esophageal replacement in patients with esophageal atresia, the distal esophageal remnant is often left in place. We recently treated two patients who developed esophagitis in their esophageal remnants and did not respond to cimetidine and antacids. They were treated by esophagectomy at 22 and 37 years of age with relief of symptoms. One had an ulcer and stricture near the gastroesophageal junction and the second had gastric mucosa (Barrett's esophagus) replacing most of the squamous epithelium. Six additional patients were then reviewed who had resection of their distal esophageal segments between 1978 and 1987. Esophagitis was present in all. Also identified were two specimens with Barrett's esophagus and four with mural bronchial glands as well as surface respiratory and metaplastic squamous epithelium in two, and cartilagenous remnants in two. The findings of chronic inflammation in the esophageal remnant and three cases of Barrett's esophagus raise concern about the possible long-term complication of malignancy. Therefore, we recommend that esophagectomy be performed at the time of esophageal replacement if feasible, or later if symptoms occur or barium studies show esophagitis or ulceration.