Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction

Yamamoto, Sachiko; Makuuchi, Hiroyasu; Sasaki, Hideo; Chino, Osamu; Nishi, Takayuki; Kise, Yoshifumi; Kenmochi, Takahiro; Hara, Tadashi

doi:10.1007/s00535-007-2011-6

Cited by 32 publications

(39 citation statements)

References 12 publications

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“…Thus, we cannot say with certainty that the enlarged proximal gastrectomy contributed to the reduction of esophagitis and Barrett in our patients. Other authors also found the occurrence of esophagitis and Barrett's esophagus in the esophageal stump of patients with gastric tube, since its vertical position is maintained, facilitating rapid gastric emptying, as well as duodenogastric reflux 34,35,38,39 . We conducted esophagectomy with enlarged proximal gastrectomy (gastric tube) and yearly endoscopy, as experts recommend.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 93%

“…Considering that in these patients, basal and stimulated acid secretion is lower than that found in normal subjects, and the right colon may be affected by the disease, reconstitution with the stomach initially appeared to be a great option. However, the follow-up of patients submitted to esophagectomy with this type of reconstitution and without the use of proton pump inhibitor (PPI) may show disastrous complications, such as Barrett's esophagus and esophageal stump cancer 25,[33][34][35] .…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…We stress the utmost importance of the clinical follow-up and annual endoscopic exam of patients undergoing esophagogastroplasty, combined with the continued use of proton pump inhibitors, beginning in the early postoperative period in an attempt to decrease tumor development in the remaining esophageal stump 26,33,35,[40][41][42][43] . The results obtained in this study, with 50 Chagas megaesophagus patients, support the conclusion that the use of omeprazole (40 mg/day) reduced the onset of erosive esophagitis and Barrett's esophagus during the late postoperative period.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

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Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Pochini¹,

Gagliardi²,

Júnior³

et al. 2015

Rev. Col. Bras. Cir.

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Objective: To analyze the late results of advanced Chagasic megaesophagus treatment by esophagectomy associated with the use of proton pump inhibitor (omeprazole) as for the incidence of esophagitis and Barrett's esophagus in the remaining stump. Methods : We studied patients with advanced megaesophagus undergoing esophagectomy and transmediastinal esophagogastroplasty. Patients were divided into three groups: A (20) with esophageal replacement by full stomach, without the use of omeprazole; B (20) with esophageal replacement by full stomach, with omeprazole 40 mg/day introduced after the first postoperative endoscopy and maintained for six years; and C (30) with esophageal replacement by gastric tube with use of omeprazole. Dysphagia, weight loss and BMI were clinical parameters we analyzed. Upper gastrointestinal endoscopy was performed in all patients, and determined the height of the anastomosis, the aspect of the mucosa, with special attention to possible injuries arising from gastroesophageal reflux, and the patency of the esophagogastric anastomosis. Results : We studied 50 patients, 28 males (56%) and 22 (44%) females. All underwent endoscopy every year. In the first endoscopy, erosive esophagitis was present in nine patients (18%) and Barrett's esophagus, in four (8%); in the last endoscopy, erosive esophagitis was present in five patients (8%) and Barrett's esophagus in one (2%). When comparing groups B and C, there was no evidence that the manufacturing of a gastric tube reduced esophagitis and Barrett's esophagus. However, when comparing groups A and C, omeprazole use was correlated with reduction of reflux complications such as esophagitis and Barrett's esophagus (p <0.005). Conclusion : The use of omeprazole (40 mg/day) reduced the onset of erosive esophagitis and Barrett's esophagus during the late postoperative period.

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Section: Discussion Discussion Discussion Discussionmentioning

confidence: 93%

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

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Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Pochini¹,

Gagliardi²,

Júnior³

et al. 2015

Rev. Col. Bras. Cir.

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“…PPIs were also introduced to all patients during the first week after surgery in our hospital because of increased risk for prolonged esophageal exposure to gastric acid and duodenal juice. It was confirmed useful for the treatment of RE as most patients showed endoscopic improvement in the severity of the reflux after treatment (9). However, we do not encourage the long-term use of PPIs because of its negative effect on the digestive system and the relatively lower incidence of RE in Asia (19).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Health-related Quality of Life in Patients with Narrow Gastric Tube and Whole Stomach Reconstruction after Oncologic Esophagectomy: A Prospective Randomized Study

Zhang

et al. 2013

Scand J Surg

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Background andResults: The perioperative complication rate was 26.9% in narrow gastric tube group and 48.1% in whole stomach group (P = 0.31). At the time of 3 weeks after surgery, the reflux and dyspnea scores were higher in whole stomach group than in narrow gastric tube group, which meant that the patients in whole stomach group suffered more severe problem. At the time of 6 months and 1 year after surgery, the reflux scores were lower in narrow gastric tube group than in whole stomach group, which revealed that there were less problems of reflux in the patients of narrow gastric tube group; meanwhile, the score of physical function scale in narrow gastric tube group was higher conversely, which suggested that the patients gain a better status in physical function. Nausea and vomiting is the only notable symptom that was worse in whole stomach group at the time of 2 years after surgery, which suggested that patients in whole stomach group suffered more severe nausea and vomiting.Conclusions: Narrow gastric tube reconstruction may be a good alternative choice for patients undergoing oncologic esophagectomy in view of better health-related quality of life after the surgery.

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“…Using the Los Angels classification ( Table 1), Shibuya observed sever esophagitis (grade C or D) in 75% o f their patients [17]. In another series of 48 patients , Yamamoto [18] found reflu x esophagitis in 27 o f their 48 patients (56.3%) and majority (70%) had a Los Angeles C or D damage.…”

Section: Reflux Esophagitismentioning

confidence: 97%

Duodenogastric Reflux after Esophagectomy and Gastric Interposition

Hashimoto¹

2014

OALib

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Stomach is considered the "gold standard" as an esophageal substitute after esophagectomy. Reflux disease is considered an unavoidable consequence of esophageal resection followed gastric interposition. Reflux esophagitis shows a progression from inflammation to erosions and to the development of columnar lined metaplasia. With the use of a gastric interposition, the m ost popular option to reconstruct the esophagus resected for malignant or benign conditions creates an in vivo model of reflux disease. Gastric interposition is far from ideal as an esophageal substitute. R eflux esophagitis and new columnar lined metaplasia should be seen as a new complication of subtotal esophagectomy.

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Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction

Cited by 32 publications

References 12 publications

Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

Comparison of the Health-related Quality of Life in Patients with Narrow Gastric Tube and Whole Stomach Reconstruction after Oncologic Esophagectomy: A Prospective Randomized Study

Duodenogastric Reflux after Esophagectomy and Gastric Interposition

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