Long-Term Effects of Gastric Transposition in Children: A Physiological Study By Mark Davenport, Gareth P. Hosie, Robert C. Tasker, I. Gordon, E.M. Kiely, and L. Spitz London, England 0 Gastric transposition (GT) has become a reliable alterna- tive operation for oesophageal replacement in children. The aims of this study were to assess the long-term results of the operation and to study the function of the intrathoracic stomach. Current symptoms were assessed using a question- naire and linear analogue scales. Lung function was mea- sured using spirometry and plethysmography, and the re- sults were corrected for height and expressed as a percentage of the predicted values for normal children. Gastric emptying was assessed using a dual isotope radiolabelled test meal (incorporating solid and liquid phases). Full anthropometric and haematologic data also were collected. The results are expressed as medians and interquartile ranges. Seventeen children were examined at least 5 years after GT; the median age was 9 years. Two children frequently had symptoms during swallowing. Four children had significant diarrhoeal episodes, and two had significant postprandial weakness or dizziness. Unexplained breathlessness was noted by four children. All but one child had lung function values that were lower than the mean predicted value for height. For example, the total lung capacity was 68%. and forced vital capacity (FVC) was 64%. However, the ratio of forced expiratory volume in 1 second (FEV,) to FVC was normal. The gastric emptying study showed that the intrathoracic stomach in all subjects served as a conduit (rather than a reservoir) for both liquids and solids. Rapid emptying (>50%) in both phases occurred within 5 minutes of ingestion in 82% of the group. Thirteen children were between the 3rd and 97th percentiles for height, and 11 in this range for weight. Five children were anaemic (~11.5 g/dL). In 11 of the tested samples, the serum ferritin was low, indicating depleted iron stores. GT is compatible with an entirely normal life and has allowed satisfactory growth and nutrition for the majority of subjects in this study group. Copyright o 1996 by W.B. Saunders Company INDEX WORDS: Gastric transposition, oesophageal atresia, pulmonary function, gastric emptying. G ASTRIC TRANSPOSITION (GT) with cre- ation of an intrathoracic stomach has been our procedure of choice for oesophageal replacement surgery since 1981. The operation is well tolerated in children, and the single proximal oesophago-gastric From the Institute of Child Health and The Great Ormond Street Hospital for Children, London, England. Presented at the 42nd Annual International Congress of the Btitish Association of Paediatric Surgeons, Shefield, England, Judy 25-28, 1995. Address reprint requests to Professor L. Spitz, Department of Paediattic Surgery, Institute of Child Health, London WClN IEH, England. Copyright o 1996 by KB. Saunders Company 0022-3468/9613104-0028$03.OOlO 588 anastomosis heals reliably with minimal morbidity. The early experience with this operation has been the subject of previous reports,1,2 and to date more than 90 children have undergone this operation at The Great Ormond Street Hospital for Children, London. GT is commonly performed in adults as a curative or palliative operation for pharyngeaP or oesopha- geal carcinoma, and any untoward problems gener- ally have been tolerated. The physiological behaviour of the intrathoracic stomach (eg, gastric emptying, acid secretion, and motility4-8 has been studied only in adults, and the results have been conflicting. The life expectancy of children who have undergone GT is much longer, and problems that have been tolerated by or minimised in adults may assume greater impor- tance for children. The intrathoracic stomach should allow for normal swallowing of a normal diet and the achievement of maximal growth potential. The aims of the present study were to provide a structured long-term assess- ment of children with an intrathoracic stomach and to assess some aspects of its physiological function and behaviour. MATERIALS AND METHODS Children who had had GT more than 5 years previously were recruited for this study. Their parents were contacted, either during routine follow-up or through postal invitation. The study and its methodology were approved by our institution’s Research Ethics Committee, and parental consent was obtained in all cases. The follow-up study was conducted in five sections, as described below. 1. Symptom/Lifestyle Questionnaire A structured questionnaire was designed, which enquired about feeding habits, swallowing difficulties, diarrhoeal episodes, respira- tory symptoms, sleep disturbances, frequency of chest infections, and current lifestyle (eg, time off from school, number of hospital admissions). A question regarding “satisfaction” with the results of the operation also was included. Linear analogue scales were used as much as possible for the answers to questions. 2. Anthropometry The nutritional status of the child was assessed using anthropo- metric criteria. Height (in centimeters), weight (in kilograms), triceps skinfold thickness (in millimeters), and midarm circumfer- ence (in millimeters) were measured. For the latter two variables, the mean of three measurements on each side was obtained using standard dietetic calipers. Arm muscle area and arm fat area were calculated using the following standard formulas, and a compari- JournalofPediatric Surgery, Vol31, No 4 (April), 1996: pp 588-593