Multidimensional long-term outcomes after pediatric esophageal replacement following caustic injuries: a comparative study of two techniques

Objective This study aimed to compare multidimensional long-term outcomes between children who underwent colonic pedicled flap surgery versus gastric tube esophageal replacement in the mediastinum after caustic injuries. Methods This cross-sectional observational study was conducted patients who were operated on during their childhood between 1989 and 2022. Patients completed a comprehensive assessment using Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale (PedsQL GI), KIDSCREEN-52 for psychosocial dimensions, the 36-Item Short Form Health Survey, the International Dysphagia Diet Standardization Initiative (IDDSI) scale and the 6-Minute Walk Test (6MWT). Results A total of 26 patients (aged 6–22 years with mean 14 years) were included. Among these, 17 had a colonic pedicled flap and 9 had a gastric tube. Mean operation-to-questionnaire interval was 8 years. No significant differences were observed between groups in PedsQL GI, SF-36 or 6MWT outcomes. Mean PedsQL GI scores indicated mild-to-moderate gastrointestinal symptoms, with lower score in trouble swallowing and heartburn and reflux. Significant psychosocial disparities emerged in KIDSCREEN-52 with higher scores in psychological well-being (p<0.05) for colonic patients. Dietary texture modifications were needed in 38% of patients (IDDSI levels 5 and 6), but these were equally distributed between groups. Conclusion Both colonic and gastric esophageal replacements provide satisfactory long-term outcomes and quality of life after pediatric caustic injury. Although gastrointestinal and functional results were comparable, psychosocial quality of life domains showed differences. Persistent dietary adaptations underline the necessity for tailored, multidisciplinary and culturally sensitive follow-up.