Colonic interposition for esophageal substitution.

Sufficient information has now accumulated to permit a better definition of the role of colonic interposition for substitution of the esophagus. For children and young adults with a long life expectancy, the interposed colon provides a well-functioning and durable conduit. When the stomach cannot be used, the colon is the best alternative in most patients. Necrosis of the colon remains the most frequent fatal complication; leakage and stenosis of the proximal anastomosis remain problems. Although results of the usual radiologic examinations with barium show that the colon empties by gravity, manometric results may demonstrate progressive peristalsis, particularly in response to stimulus from a bolus of dilute acid.