Children face lasting challenges after caustic esophageal injury surgery

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

On February 3, 2026, researchers at Lausanne University Hospital in Switzerland and their colleagues in Benin published a comparative study (DOI: 10.1136/wjps-2025-001109). World Journal of Pediatric Surgery (WJPS) To investigate the long-term outcomes of children undergoing 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 who had surgery in childhood between 1989 and 2022; 17 received a colonic pedicled flap and 9 received a gastric tube, with a mean follow-up interval of approximately 8 years. To capture recovery in a comprehensive and more humanistic way, the team combined several validated instruments: the Child Quality of Life Inventory Gastrointestinal Symptoms scale (PDQL GI) for digestive symptoms, the KidsScreen-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 optimization, and the 6 for physical performance. Minute Walk Test (6MWT). The results painted a nuanced picture. Gastrointestinal symptoms were generally mild to moderate in both groups, with the lowest scores observed for difficulty swallowing 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 required modified textured diets for safe swallowing, and 11.5% (3/26) were underweight (body mass index (BMI)).

According to the research team, the most important lesson is that successful esophageal reconstruction should not be measured solely by whether the new esophagus functions physically. Children may appear clinically stable while still experiencing silent challenges with swallowing, feeding, emotional adjustment, or social participation. The authors emphasize that these outcomes may also be shaped by socio-economic context and how symptoms are understood and reported. In that sense, the study shifts attention away from just the surgical technique and onto the broader long-term experience of recovery.

The implications extend far beyond this small group. For pediatric surgeons, the findings support both colonic and gastric replacement as acceptable options when severe caustic injury destroys the esophagus. For physicians and caregivers, the study emphasizes 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 conducted as children reach adulthood may help to refine surgical options, identify previously hidden vulnerabilities, and improve how to support recovery after one of the most devastating accidental injuries of childhood.