Children face lasting challenges after caustic esophageal injury surgery

Caustic ingestion remains a serious pediatric health problem, especially in domestic settings where corrosive substances may be improperly stored. While some children recover with conservative treatment such as repeated endoscopic dilatation, severe injuries involving long or multiple strictures often require esophageal replacement. However, choosing the best substitute for the damaged esophagus remains controversial. Surgical success has traditionally been judged by perioperative safety and anatomical repair, while long-term digestive function, quality of life, and social reintegration have been less well characterized. These gaps are even more important in low-resource settings, where culture, access to care, and daily hardship may shape how symptoms are experienced and reported. Based on these challenges, in-depth research on long-term multidimensional outcomes after pediatric esophageal replacement is needed.

On February 3, 2026, researchers from Lausanne University Hospital in Switzerland and their collaborators in Benin published a comparative study (DOI: 10.1136/wjps-2025-001109) in World Journal of Pediatric Surgery (WJPS) investigating the long-term outcomes of children who underwent colonic or gastric esophageal replacement after caustic injury, using gastrointestinal, psychosocial, nutritional, and physical assessments to evaluate quality of life after surgery.

The study included 26 patients, aged 6 to 22 years, who had undergone surgery in childhood between 1989 and 2022; 17 received a colonic pedicled flap and 9 received a gastric tube, with an average follow-up interval of about 8 years. To capture recovery in a broader and more human way, the team combined several validated tools: Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale (PedsQL GI) for digestive symptoms, KIDSCREEN-52 for psychosocial well-being, the 36-Item Short Form Health Survey (SF-36) for general health, the International Dysphagia Diet Standardization Initiative (IDDSI) scale for diet texture adaptation, and the 6-Minute Walk Test (6MWT) for physical performance. The results painted a nuanced picture. Gastrointestinal symptoms were generally mild to moderate in both groups, with the lowest scores seen in swallowing difficulty and heartburn or reflux. No significant differences emerged between the two surgical techniques in digestive symptoms, overall health perceptions, or walking performance. Nevertheless, 38% (10/26) of patients needed modified texture diet for safe swallowing, and 11.5% (3/26) were underweight (body mass index (BMI) <-2 SD). Psychosocial findings were more mixed: the colonic group showed better scores in psychological well-being, moods and emotions, and bullying-related measures, while the gastric group scored better in parent relations and home life as well as financial resources. Overall, the findings suggest that both techniques are viable, but neither fully eliminates the need for long-term multidisciplinary follow-up and supportive care.

According to the research team, the most important lesson is that successful esophageal reconstruction should not be measured only by whether the new esophagus works anatomically. Children may appear clinically stable while still facing silent challenges in swallowing, diet, emotional adjustment, or social participation. The authors emphasize that these outcomes can also be shaped by socioeconomic context and by how symptoms are perceived and reported. In that sense, the study shifts attention from surgical technique alone to the broader long-term experience of recovery.

The implications extend well beyond this small cohort. For pediatric surgeons, the findings support both colonic and gastric replacement as acceptable options when severe caustic injury destroys the esophagus. For clinicians and caregivers, the study underscores the need for multidisciplinary, culturally sensitive follow-up that includes nutritional guidance, psychosocial care, and long-term functional monitoring. For global child health programs, it also highlights the value of sustained international collaboration rather than one-time surgical intervention. Future prospective studies following children into adulthood may help refine surgical choice, identify hidden vulnerabilities earlier, and improve how recovery is supported after one of childhood's most devastating accidental injuries.

Source:

Zhejiang University

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