Comparative Outcomes of Esophageal Replacement Techniques

Esophageal replacement (ER) procedures have been widely used to replace the native esophagus over the past few decades. Although satisfactory results have been reported in different ER procedures, controversies exist about the best surgical technique with least complications. There is limited number of comparative studies evaluating the results of different ER techniques. Most of these studies include data from heterogeneous group of patients with different indications. Therefore, without randomized controlled studies, it is difficult to make a strong recommendation about the best surgical option. The previous studies demonstrate that minor complications are more common after colonic substitutions (CS) than gastric pull-up (GPU) procedures, whereas major complications are more frequent after GPU's. In a meta-analysis, CS was shown to be associated with gastrointestinal complications, but fewer respiratory complications than GPU. The results of JI are highly divergent and commonly depend on the experience of surgeons and centers. Finally, mortality rates associated with different surgical techniques were similar. In conclusion, no single ER procedure is better than the other. Current evidence on short-and long-term outcomes of ER is limited and needs to be further evaluated. There is no clear evidence in literature about one conduit being superior to the other. The choice of the conduit still depends on surgeon's preference, patient's anatomy, and experience of the center.