Multidimensional Long-Term Outcomes After Pediatric Esophageal Replacement Following Caustic Injuries: A Comparative Study of Two Techniques

Background Accidental ingestion of caustic substances is a significant pediatric health concern, potentially causing severe long-term gastrointestinal, nutritional, and psychosocial consequences. Aims This study aims to compare multidimensional long-term outcomes between children who underwent colonic pedicled flap versus gastric tube esophageal replacement in the mediastinum after caustic injuries. Methods This cross-sectional observational study was conducted during 2023-2024 in Benin and Togo through a Swiss-African surgical collaboration. Patients were operated on during their childhood between 1989 and 2022. They completed a comprehensive assessment using validated tools: Pediatric Quality of Life Inventory™ Gastrointestinal Symptoms Scale (PedsQL GI), KIDSCREEN-52 for psychosocial dimensions, SF-36 for general health perceptions, the International Dysphagia Diet Standardization Initiative (IDDSI) scale for dietary adaptation, and the Six-Minute Walk Test (6MWT) with the modified Borg scale for physical capacity. Results 26 patients (aged 6–22 years, mean 14 years) were included. Among them, 17 had a colonic pedicled flap and nine a gastric tube. The mean operation-to-questionnaire interval was 8 years. No significant differences were observed between both groups in PedsQL GI, SF-36, or 6MWT outcomes. Mean PedsQL GI scores indicated mild-to-moderate gastrointestinal symptoms (lowest scores in 'Trouble swallowing': colonic 71 vs. gastric 69; 'Heartburn and reflux': colonic 75 vs. gastric 63). Significant psychosocial disparities emerged in KIDSCREEN-52, notably 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), equally distributed between groups. Conclusion Both colonic and gastric esophageal replacements provide satisfactory long-term functional outcomes with subtle psychosocial differences. Persistent dietary adaptations and gastrointestinal symptoms underline the necessity of tailored, multidisciplinary, and culturally sensitive follow-up.