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Intrinsic esophageal innervation in esophageal atresia without fistula

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Abstract

Esophageal atresia and tracheo-esophageal fistula (EA + TEF) are often associated with malformations of neural crest origin. Esophageal innervation is also derived from the neural crest and it is abnormal in EA + TEF in which there is motor dysfunction. Our aim was to examine the intrinsic esophageal innervation in children with isolated EA in which different embryogenic mechanisms might be involved. Specimens from the proximal and distal esophageal segments of 6/35 patients who had esophageal replacement for isolated EA between 1965 and 2006 were suitable for the study. They were sectioned and immunostained with anti-neurofilament (NF) and anti-S-100 antibodies. The muscle and neural surfaces on each section were measured with the assistance of image processing software. The surface of the ganglia and the number of neurons per ganglion were determined at high power microscopy. The findings were compared with those of six autopsy specimens from newborns dead of other diseases by means of standard statistical tests and a significance threshold of P < 0.05. Unmatched age/size of babies in isolated EA and control groups precluded comparison of the relative surfaces occupied by neural elements. Patients with pure EA had denser fibrilar network and larger ganglia than controls. The number of neurons/ganglion were similar in both groups although the cells from EA patients were larger. The findings were similar at both esophageal levels studied. In spite of methodologic biases, it seems that intrinsic esophageal fibrilar network is denser and the intramural ganglia larger with larger cells in patients with pure EA than in controls on both esophageal ends of the organ. These neural anomalies are only in part reminiscent of those described in regular EA/TEF but may as well explain esophageal dysfunction in patients with repaired isolated EA.

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Acknowledgments

Supported in part by FIS (06/0486 and 06/0447) and FMM Grants. F.P. is a Research Fellow of the CAM (FPI-000760 Grant)

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Authors and Affiliations

  1. Department of Pediatric Surgery, Hospital Universitario “La Paz”, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Federica Pederiva, Emilio Burgos, Leopoldo Martinez & Juan A. Tovar

  2. Policlinico Universitario G.Martino, Messina, Italy

    Isabella Francica & Biagio Zuccarello

Authors
  1. Federica Pederiva
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  2. Emilio Burgos
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  3. Isabella Francica
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  4. Biagio Zuccarello
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  5. Leopoldo Martinez
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  6. Juan A. Tovar
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Corresponding author

Correspondence to Juan A. Tovar.

Additional information

Presented at the 20th International Symposium on Pediatric Surgical Research, Bern, Switzerland, 5–6 October 2007.

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Pederiva, F., Burgos, E., Francica, I. et al. Intrinsic esophageal innervation in esophageal atresia without fistula. Pediatr Surg Int 24, 95–100 (2008). https://doi.org/10.1007/s00383-007-2032-5

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  • DOI: https://doi.org/10.1007/s00383-007-2032-5

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