The Gastric Tube

  • Gabriel O. IonescuEmail author
  • Simona Gavrilescu
  • Gabriel Aprodu


“The best esophagus is the native esophagus” [1–3] is an almost universally accepted belief and has spawned a number of techniques designed to salvage the injured oesophagus or to permit an anastomosis where there is inadequate length in an atretic organ.


Oesophageal atresia Long gap Gastric tube Outcome Technique 



The authors thank to Prof. Pediatric Surgery Larry Hadley, Durban, South Africa for his kindness and expertise to review the content, editing and language of the manuscript.


  1. 1.
    McCollum MO, Rangel SJ, Blair GK, et al. Primary reversed gastric tube reconstruction in long gap esophageal atresia. J Pediatr Surg. 2003;38:957–62.CrossRefPubMedGoogle Scholar
  2. 2.
    Orsoni P. Oesophagoplastie. Paris: Libraries Malone SA; 1969.Google Scholar
  3. 3.
    Othersen Jr HB, Parker EF, Chandler J, et al. Save the child’s esophagus, part II: colic patch repair. J Pediatr Surg. 1997;32:328–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Pedersen JC, Klein RL, Andrews DA. Gastric tube as the primary procedure for pure esophageal atresia. J Pediatr Surg. 1996;31:1233–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Ahmad SA, Sylvester KG, Hebra A, et al. Esophageal replacement using the colon: is it a good choice? J Pediatr Surg. 1996;31:1026–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Badnassy AF, Bassiouny IE. Esophagocoloplasty for caustic stricture of the esophagus: changing concepts. Pediatr Surg Int. 1993;8:103–8.Google Scholar
  7. 7.
    Burgos L, Barrena S, Andres AM, et al. Colonic interposition for esophageal replacement in children remains a good choice: 33 years median follow-up of 65 patients. J Pediatr Surg. 2010;45:341–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Dickson JAS. Esophageal substitution with colon – the Waterston operation. Pediatr Surg Int. 1996;11:224–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Hamza AF. Colonic replacement in cases of esophageal atresia. Semin Pediatr Surg. 2009;18:40–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Davenport M, Hosie GP, Tasker RCF, et al. Long-term effects of gastric transposition in children: a physiological study. J Pediatr Surg. 1996;31:588–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Gupta DK, Kataria R, Bajpai M. Gastric transposition for esophageal replacement in children – an Indian experience. Eur J Pediatr Surg. 1997;7:143–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Spitz L. Gastric transposition for esophageal replacement. Pediatr Surg Int. 1996;11:218–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Spitz L. Gastric transposition in children. Semin Pediatr Surg. 2009;18:30–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Anderson KD. Gastric tube esophagoplasty. Prog Pediatr Surg. 1986;19:55–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Aprodu G, Botez C, Munteanu V. Esophagoplasty for esophageal stenosis due to caustic injuries in children: personal experience. J Pediatr Surg Spec. 2007;1:12–6.Google Scholar
  16. 16.
    Ein SH, Shandling B, Simpson JS, et al. Fourteen years of gastric tube. J Pediatr Surg. 1978;13:638–42.CrossRefPubMedGoogle Scholar
  17. 17.
    Ein SH. Gastric tubes in children with caustic injury: a 32-year review. J Pediatr Surg. 1998;33:1393–5.CrossRefGoogle Scholar
  18. 18.
    Ionescu GO, Tuleasca I. Une nouvelle technique d’oesophagoplasie par tube gastrique chez l’enfant. Chir Pediatr. 1985;26:328–30.PubMedGoogle Scholar
  19. 19.
    Bax NM, Van Renterghem KM. Ileal pedicle grafting for esophageal replacement in children. Pediatr Surg Int. 2005;21:369–72.CrossRefPubMedGoogle Scholar
  20. 20.
    Cauchi JA, Buick RG, Gornall P, et al. Oesophageal substitution with free and pedicled jejunum: short – and long term outcome. Pediatr Surg Int. 2007;23:11–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Prevot J, Lepelley M, Schmitt M. Small bowel esophagoplasty with vascular microanastomoses in the neck for treatment of esophageal burns in childhood. Prog Pediatr Surg. 1985;18:108.117.Google Scholar
  22. 22.
    Spicer RD, Cusick EL. Oesophageal substitution by jejunal free graft: follow-up data and evaluation. Pediatr Surg Int. 1996;11:227–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Chokshi NK, Guner YS, Ndiforchu F, et al. Combined laparoscopic and thoracoscopic esophagectomy and gastric pull-up in a child. J Laparoendosc Adv Surg Tech A. 2009;19:197–200.CrossRefGoogle Scholar
  24. 24.
    Esteves E, Silva MC, Pavia KC, et al. Laparoscopic gastric pull-up for long gap esophageal atresia. J Laparoendosc Adv Surg Tech A. 2009;19:191–5.CrossRefGoogle Scholar
  25. 25.
    Esteves E, Soussa-Filho HB, Watanabe S, et al. Laparoscopic assisted esophagectomy and colon interposition for esophageal replacement in children: preliminary results of a novel technique. J Pediatr Surg. 2010;45:1053–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Juza RM, Arca MJ, Densmore JC, et al. Laparoscopic-assisted transhiatal gastric transposition for long gap esophageal atresia in an infant. J Pediatr Surg. 2010;7:1534–7.CrossRefGoogle Scholar
  27. 27.
    Kane TD, Nwomeh BC, Nadler EP. Thoracoscopic-assisted esophagectomy and laparoscopic gastric pull-up for lye injury. JSLS. 2007;11:474–80.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Hecker W, Hollman G. Correction of long segment esophageal stenoses by a colonic patch. In: Rickham PP, Hecker WC, Prevot J, editors. Progress in pediatric surgery, vol. 8. Baltimore: University Park Press; 1975. p. 81–5.Google Scholar
  29. 29.
    Chen HC, Tang YB. Microsurgical reconstruction of the esophagus. Semin Surg Oncol. 2000;19:235–45.CrossRefPubMedGoogle Scholar
  30. 30.
    Di Benedetto V, Dessanti A. Experimental technique of esophageal substitution: intrathoracic interposition of a pedunculated gastric tube (PGT) preserving cardiac function. Preliminary results. Hepato-Gastroenterology. 1998;45:2202–5.PubMedGoogle Scholar
  31. 31.
    Gounot E, Borgnon J, Huet F, et al. Isolated isoperistaltic tube interposition for esophageal replacement in children. J Pediatr Surg. 2006;41:592–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Samuel M, Burge DM, Moore IE. Gastric tube graft interposition as an oesophageal substitute. ANZ J Surg. 2001;71:56–61.CrossRefPubMedGoogle Scholar
  33. 33.
    Zani A, Pierro A, Elvassore N, et al. Tissue engineering: an option for esophageal replacement? Semin Pediatr Surg. 2009;18:57–62.CrossRefPubMedGoogle Scholar
  34. 34.
    Arul GS, Parikh D. Oesophageal replacement in children. Ann R Coll Surg Engl. 2008;90:7–12.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ein SH, Shandling B, Stephens CA. Twenty-one years experience with pediatric gastric tube. J Pediatr Surg. 1987;22:77–81.CrossRefPubMedGoogle Scholar
  36. 36.
    Goon HK, Cohen DH, Middleton AW. Gastric tube esophagoplasty-a long-term assessment. Z Kinderchir. 1985;40:21–5.PubMedGoogle Scholar
  37. 37.
    Ionescu GO, Aprodu G, Gavrilescu S. Pediatric gastric tube esophageal replacement: long term results. An Adulthood perspective. 2nd World Congress, 2007, WCPSA, Buenos Aires.Google Scholar
  38. 38.
    Jianu A. Gastrostomie und osophagoplastik. Dtsch Z Chir. 1912;118:383–90.CrossRefGoogle Scholar
  39. 39.
    Gavriliu D, Georgescu L. Esofagoplastie directa cu material gastric. Rev Stiint Med. 1951;3:33–6.Google Scholar
  40. 40.
    Gavriliu D. Chirurgia esofagului. Ed Med Bucharest. 1957.Google Scholar
  41. 41.
    Gavrilu D. Etat actuel du procede du reconstruction de l’esophage par gastric tube (138 maladaes opere). Ann Chir. 1965;19:219–24.Google Scholar
  42. 42.
    Heimlich HJ. Esophageal replacement with a reversed gastric tube. Dis Chest. 1959;36:478–93.CrossRefPubMedGoogle Scholar
  43. 43.
    Ein SH, Shandling B, Simpson JS, et al. A further look at gastric tube as an esophageal replacement in infants and children. J Pediatr Surg. 1973;8:859–68.CrossRefPubMedGoogle Scholar
  44. 44.
    Burrington JD, Stephens CA. Esophageal replacement with a gastric tube in infants and children. J Pediatr Surg. 1968;3:24–52.CrossRefPubMedGoogle Scholar
  45. 45.
    Adegboye VO, Brimmo A, Adebo OA. Transhiatal esophagectomy in children with corrosive esophageal stricture. Afr L Med Sci. 2000;29:223–6.Google Scholar
  46. 46.
    Kunath U. Blunt dissection of the esophagus. Chirurg. 1980;51:296–302.PubMedGoogle Scholar
  47. 47.
    Orringer MB, Sloan H. Oesophagiectomy without thoracotomy. J Thorac Cardiovasc Surg. 1978;76:643–54.PubMedGoogle Scholar
  48. 48.
    Rodgers BM, Ryckman FC, Talbert JL. Blunt transmediastinal total esophagectomy with simultaneous substernal colon interposition for oesophageal caustic strictures in children. J Pediatr Surg. 1981;16:184–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Andres AM, Burgos A, Encinas JL, et al. What can we do when an esophagocoloplasty fails? Cir Pediatr. 2007;20:39–43.PubMedGoogle Scholar
  50. 50.
    Dunn JC, Fonkalsrud EW, Applebaum H, et al. Reoperation after esophageal replacement in childhood. J Pediatr Surg. 1999;34:1630–2.CrossRefPubMedGoogle Scholar
  51. 51.
    Schilling MK, Mettler D, Redaelli C, et al. Circulatory and anatomic differences among experimental gastric tubes as esophageal replacement. World J Surg. 1997;21:992–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Harmel RP. Esophageal replacement in two siblings with epidermolysis bullosa. J Pediatr Surg. 1986;21:175–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Nishikawa K, Matsudaira H, Suzuki H, et al. Intraoperative thermal imaging in esophageal replacement: its use in the assessment of gastric tube viability. Surg Today. 2006;36:802–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Lazar G, Kaszaki J, Abraham S, et al. Thoracic epidural anesthesia improves the gastric microcirculation during experimental gastric tube formation. Surgery. 2003;134:799–805.CrossRefPubMedGoogle Scholar
  55. 55.
    Al-Shanafey S, Harvey J. Long gap esophageal atresia: an Australian experience. J Pediatr Surg. 2008;43:597–601.CrossRefPubMedGoogle Scholar
  56. 56.
    Avila LF, Encinas JL, Andres AM. Esophageal replacement. 12 years experience. Cir Pediatr. 2006;42:636–40.Google Scholar
  57. 57.
    Holland AJ, Ron O, Pierro A, et al. Surgical outcomes of esophageal atresia without fistula for 24 years at a single institution. J Pediatr Surg. 2009;44:1928–32.CrossRefPubMedGoogle Scholar
  58. 58.
    Lindahl H, Rintala R, Louhimo I. Results of gastric tube esophagoplasty in esophageal atresia. Pediatr Surg Int. 1987;2:282–6.Google Scholar
  59. 59.
    Sri Paran T, Decaluwe D, Corbally M, et al. Long-term results of delayed primary anastomosis for pure oesophageal atresia: A 27 years follow up. Pediatr Surg Int. 2007;23:647–51.CrossRefPubMedGoogle Scholar
  60. 60.
    Aprodu SG, Gavrilescu S, Savu B, et al. Indications for esophageal replacement in children. Rev Med Chir Soc Med Nat Iasi. 2004;108:805–8.PubMedGoogle Scholar
  61. 61.
    Mutaf O. Esophagoplasty for caustic esophageal burns in children. Pediatr Surg Int. 1992;7:106–8.CrossRefGoogle Scholar
  62. 62.
    Panieri E, Rode H, Millar AJW, et al. Esophageal replacement in the management of corrosive stricture: when is surgery indicated? Pediatr Surg Int. 1998;13:336–40.CrossRefPubMedGoogle Scholar
  63. 63.
    Panieri E, Millar AJW, Rode H, et al. Iatrogenic esophageal perforation in children: patterns of injury, presentation, management and outcome. J Pediatr Surg. 1996;31:890–5.CrossRefPubMedGoogle Scholar
  64. 64.
    Rappert P, Preier L, Korab W, et al. Diagnostic and therapeutic management of esophageal and gastric burns in childhood. Eur J Pediatr Surg. 1993;3:202–5.CrossRefPubMedGoogle Scholar
  65. 65.
    Ul-Haq A, Tareen F, Bader I, et al. Oesophageal replacement in children with indolent stricture of the oesophagus. Asian J Surg. 2006;29:17–21.CrossRefPubMedGoogle Scholar
  66. 66.
    Foker JE, Linden BC, Boyle EM, et al. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg. 1997;226:533–41.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Khan KM, Foker LE. Use of high-resolution endoscopic ultrasonography to examine the effect of tension on the esophagus during primary repair of long gap esophageal atresia. Pediatr Radiol. 2007;37:41–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Khan KM, Sabati AA, Kendall T, et al. The effect of traction on esophageal structure in children with long-gap esophageal atresia. Dig Dis Sci. 2006;51:1917–21.CrossRefPubMedGoogle Scholar
  69. 69.
    Lopes MF, Reis A, Coutinho S, et al. Very long gap esophageal atresia successfully treated by esophageal lengthening using external traction sutures. J Pediatr Surg. 2004;39:1286–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Till H, Muensterer OJ, Rolle, et al. Staged esophageal lengthening with internal and subsequent external traction sutures leads to primary repair of an ultra long gap esophageal atresia with upper pouch tracheoesophageal fistula. J Pediatr Surg. 2008;43:35–5.CrossRefGoogle Scholar
  71. 71.
    Tamburri N, Laje P, Boglione M, et al. Extrathoracic esophageal elongation (Kimura’s technique): a feasible option for treatment of patients with complex esophageal atresia. J Pediatr Surg. 2009;44:2420–5.CrossRefPubMedGoogle Scholar
  72. 72.
    Cardanel S, Scaillon M, Goyens P, et al. Treatment of esophageal caustic injuries: experience with high –dose dexamethasone. Pediatr Surg Int. 1993;8:97–102.Google Scholar
  73. 73.
    Morikawa N, Honna T, Kuroda T, et al. High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone. Pediatr Surg Int. 2008;24:1161–4.CrossRefPubMedGoogle Scholar
  74. 74.
    Bicakci U, Tander B, Deveci G, et al. Minimally invasive management of children with caustic ingestion: less pain for patients. Pediatr Surg Int. 2010;26:251–5.CrossRefPubMedGoogle Scholar
  75. 75.
    Okada T, Ohnuma N, Tanabe M, et al. Effective endless-loop bougienage through the oral cavity and esophagus to the gastrostomy in corrosive esophageal strictures in children. Pediatr Surg Int. 1998;13:480–6.CrossRefPubMedGoogle Scholar
  76. 76.
    Saleem MM. Acquired oesophageal strictures in children: emphasis on the use of string guided dilatations. Singap Med J. 2009;50:82–6.Google Scholar
  77. 77.
    Atabek C, Surer I, Demirbag S. Increasing tendency in caustic esophageal burns and long-term polytetrafluorethylene stenting in severe cases: 10 years experience. J Pediatr Surg. 2007;42:636–40.CrossRefPubMedGoogle Scholar
  78. 78.
    Han Y, Liu K, Li X, et al. Repair of massive stent-induced tracheoesophageal fistula. J Thorac Cardiovasc Surg. 2009;137:813–7.CrossRefPubMedGoogle Scholar
  79. 79.
    Pianzola HM, Otino A, Canestri M. Cystic duplication of the esophagus. Acta Gastroenterol Latinoam. 2001;31:333–8.PubMedGoogle Scholar
  80. 80.
    Diaz M, Leal N, Olivares P, et al. Infectious strictures requiring esophageal replacement in children. J Pediatr Gastroenterol Nutr. 2001;32:611–6.CrossRefPubMedGoogle Scholar
  81. 81.
    Sanders GB. Esophageal replacement with reversed gastric tube. Utilisation for bleeding esophageal varices in a four-year-old child. JAMA. 1962;181:944–7.CrossRefPubMedGoogle Scholar
  82. 82.
    Khan AR, Stiff G, Mohammed AR, et al. Esophageal replacement with colon in children. Pediatr Surg Int. 1998;13:79–83.CrossRefPubMedGoogle Scholar
  83. 83.
    Randolph JG. The reversed gastric tube for esophageal replacement in children. Pediatr Surg Int. 1996;11:221–3.CrossRefPubMedGoogle Scholar
  84. 84.
    Schettini ST, Pinus J. Gastric-tube esophagoplasty in children. Pediatr Surg Int. 1998;14:144–50.CrossRefPubMedGoogle Scholar
  85. 85.
    Scharli AF. Esophageal reconstruction in very long atresias by elongation of lesser curvature. Pediatr Surg Int. 1992;7:101–5.CrossRefGoogle Scholar
  86. 86.
    Scharli AF. Esophageal reconstruction by elongation of the lesser gastric curvature. Pediatr Surg Int. 1996;11:214–7.CrossRefPubMedGoogle Scholar
  87. 87.
    Schettini ST, Ganc A, Saba L. Esophageal carcinoma secondary to a chemical injury in a child. Pediatr Surg Int. 1998;13:519–20.CrossRefPubMedGoogle Scholar
  88. 88.
    Ionescu GO, Tuleasca I, Ioan F, et al. L’oesophagoplastie par tube gastrique chez l’enfant. Chir Pediatr. 1979;20:47–51.PubMedGoogle Scholar
  89. 89.
    Saldana-Cortes JA, Larios-Arceo F, Prieto-Diaz-Chavez E, et al. Role of fibrin glue in the prevention of cervical leakage and strictures after esophageal reconstruction of caustic injury. World J Surg. 2009;33:986–93.CrossRefPubMedGoogle Scholar
  90. 90.
    Lindecken KD, Kunath U, Janson R. Esophageal replacement by an isoperistaltic gastric tube. Langenbecks Arch Chir. 1981;354:265–71.CrossRefPubMedGoogle Scholar
  91. 91.
    Borgnon J, Touian P, Auber F, et al. Esophageal replacement in children by an isoperistaltic gastric tube: a 12 years experience. Pediatr Surg Int. 2004;20:829–33.CrossRefPubMedGoogle Scholar
  92. 92.
    Sitges AC, Sanchez-Ortega JM, Sitges AS. Late complications of reversed gastric tube oesophagoplasty. Thorax. 1986;41:61–5.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Choi RS, Lillehei CW, Lund DP, et al. Esophageal replacement in children who have pharyngoesophageal strictures. J Pediatr Surg. 1997;32:1083–7.CrossRefPubMedGoogle Scholar
  94. 94.
    Collard JM, Tinton N, Malaise J, et al. Esophageal replacement: gastric tube or whole stomach? Ann Thorac Surg. 1995;60:261–6.CrossRefPubMedGoogle Scholar
  95. 95.
    Lindahl H, Louhimo I, Virkola K. Colon interposition or gastric tube? Follow-up study of colon-esophagus and gastric tube-esophagus patients. J Pediatr Surg. 1983;18:58–63.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Gabriel O. Ionescu
    • 1
    Email author
  • Simona Gavrilescu
    • 1
  • Gabriel Aprodu
    • 1
  1. 1.Department of Pediatric SurgeryUniversity Children Hospital “St. Marry”IasiRomania

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