Erythromycin Enhances Early Postoperative Contractility of the Denervated Whole Stomach as an Esophageal Substitute

Collard, Jean-Marie; Romagnoli, Renato; Otte, Jean-Bernard; Pj, Kestens

doi:10.1097/00000658-199903000-00006

Cited by 43 publications

(44 citation statements)

References 22 publications

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“…6 Intraluminal acidity in the current study was not affected by erythromycin, a drug that enhances both antral motility 7 and emptying 15 after vagotomy, and it was even lower in the absence than in the presence of a gastric drainage procedure. Moreover, although gravity plays a critical role in the emptying of the intrathoracic denervated stomach, 16 intraluminal acidity beyond 3 years was similar to that in controls whatever the patient's position (upright vs. supine).…”

Section: Group 3 (N ‫؍‬ 42)mentioning

confidence: 41%

“…This is true irrespective of the level of the anastomosis (intrathoracic vs. cervical), the suture technique used (manual vs. semimechanical), the presence or absence of a gastric drainage procedure, and enhancement of antral motility by erythromycin 7,15 or not. Gastroesophageal reflux may even lead to the development of metaplastic changes in the esophageal remnant, 26,27 either gastric or intestinal in type.…”

Section: Group 3 (N ‫؍‬ 42)mentioning

confidence: 99%

“…This process may be accelerated dramatically by early administration of erythromycin. 7,15 The second process consists of the reappearance of a normal intraluminal acidity, with subsequent deterioration of the alimentary comfort because of the development of disabling reflux symptoms and cervical esophagitis. However, because they are unusual at short-term follow-up, 9 reflux symptoms do not alter alimentary comfort in most patients who cannot anticipate long-term survival after esophagectomy for advanced neoplastic disease.…”

Section: Group 3 (N ‫؍‬ 42)mentioning

confidence: 99%

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Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

Gutschow¹,

Collard²,

Romagnoli³

et al. 2001

Annals of Surgery

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ObjectiveTo determine whether the denervated stomach as an esophageal substitute recovers normal intraluminal acidity with time. Summary Background DataBilateral truncal vagotomy to the stomach as an esophageal substitute reduces both gastric acid production and antral motility, but a spontaneous motor recovery process takes place over years. MethodsIntraluminal gastric pH and bile were monitored during a 24-hour period 1 to 195 months after transthoracic elevation of the stomach as esophageal replacement in 91 and 76 patients, respectively. Nine patients underwent a second gastric pH monitoring after a 3-year period. The percentages of time that the gastric pH was less than 2 and bile absorbance exceeded 0.25 were calculated in reference to values from 25 healthy volunteers. Eighty-nine upper gastrointestinal endoscopies were performed in 83 patients. Patients were divided into three groups depending on length of follow-up: group 1, less than 1 year; group 2, 1 to 3 years; group 3, more than 3 years.

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Section: Group 3 (N ‫؍‬ 42)mentioning

confidence: 41%

Section: Group 3 (N ‫؍‬ 42)mentioning

confidence: 99%

Section: Group 3 (N ‫؍‬ 42)mentioning

confidence: 99%

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Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

Gutschow¹,

Collard²,

Romagnoli³

et al. 2001

Annals of Surgery

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“…Early prokinetic administration (ex. eritromycin) seems to dramatically accelerate this restorative process (43)(44).…”

Section: Discussionmentioning

confidence: 99%

“…So I think this can explain the much weaker response to motilide (erythromycin) stimulation of those with gastric tube reconstruction (43).…”

Section: Discussionmentioning

confidence: 99%

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Predescu¹,

Constantinoiu²

2018

chr

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RezumatÎn urmă cu câteva decade, substituţia esofagiană se adresa în special cazurilor de stenoze esofagiene postcaustice; actual, reconstrucţia şi-a lărgit paleta indicaţiei şi pentru alte domenii din patologia esofagiană benignă (tulburări motorii severe, acalazie multi-recidivată, stenoze peptice, etc.) dar a devenit şi un timp final cvasi-obligatoriu în exereza esofagiană pentru cancer ori de câte ori gestul este posibil. Tehnicile de reconstrucţie esofagiană ce folosesc potenţialul visceral al stomacului, indiferent de indicaţie şi varianta tehnică aleasă, rămân o metodă valoroasă şi eficace. O serie de argumente redutabile pledează pentru un tip sau altul de grefon gastric: factori anatomici mai mult decât convenabili (vascularizaţie, lungime suficientă, structură parietală competentă pentru sutură, etc.) şi un act operator sustenabil (durată, abord, complexitate timpi operatori, tulburări digestive post-grefare, funcţionalitate postterapeutică, etc). Opţiunea pentru o tehnică sau alta, dincolo de argumente patologice, trebuie să ţină cont de funcţionalitatea la distanţă, cu evident impact pe status-ul metabolic şi calitatea vieţii. Deci putem argumenta funcţional un montaj gastric sau altul funcţie de acest criteriu? În final, dovada unei rezolvări adecvate este relativ facil de apreciat: a fost restabilită deglutiţia şi dacă da, rezultatul s-a menţinut în timp? Pentru cazurile oncologice evaluarea trebuie să ţină seama şi de criteriul cronologic al ratei de supravieţuire postoperatorii. Metodă: Lotul evaluat statistic s-a întins pe perioada 1981 -2016 şi a cuprins un număr de 268 de pacienţi operaţi pentru stenoze esofagiene, repartizaţi în funcţie de etiopatogenie şi indicaţie în 201 de reconstrucţii pentru cauze stenotice post-caustice şi 67 pentru substituţie post-ablativă de cauză neoplazică. Tehnicile utilizate pentru evaluarea funcţională la distanţă au cuprins: prânz radio-opac, ex.endoscopic + biopsie, iar la cazuri cu modificări evidente pH-metrie/24h şi manometrie şi excepţional scintigrafie cu alimente marcate. Rezultate: Au fost identificate două tipuri de probleme: un tip particular de disfuncţie neuromotorie a substitutului esofagian la 6 pacienţi (1 reconstrucţie tip Gavriliu şi 5 cu tot stomacul Nakayama), evacuarea grefonului fiind dificilă, întârziată, cu stază importantă şi disconfort alimentar (vărsături, inabilitatea alimentaţiei, fenomene aspirative) respectiv o patologie de reflux -8 bolnavi, fiind argumentată de o simptomatologie specifică, de prînzul baritat, de examenul endoscopic şi de examen-ul pH-metric. Refluxul avea un caracter alcalin la 7 pacienţi, toţi cu piloroplastie, 5 cu tot stomacul şi 2 cu procedeu Akiyama iar la 1 caz cu procedeu Gavriliu refluxul era acid. Concluzii: Stomacul este o obţiune redutabilă în substituţia esofagiană. În ceea ce priveşte rezultatele la distanţă se constată o funcţionalitate bună, cu un status metabolic rezonabil. Cele două fenomene de care depinde funcţional grefonul -activitate secretorie şi activitate motorie -par a se restabili odată...

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Reflux after oesophagectomy

Aly

Jamieson

2004

British Journal of Surgery

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Reflux after oesophagectomy is a significant problem, with both clinical and pathological consequences. Simple measures to facilitate gastric emptying, such as creating a gastric tube, performing a pyloric drainage procedure and using gastric motility agents, may produce a reduction in symptoms but do not alone control reflux itself. A variety of surgical reconstructions have been used, many of which are either difficult to fashion or not suitable when a radical resection has been performed. A modified fundoplication at the anastomosis seems to be the simplest technique and may be relatively effective in controlling symptoms. The impact of strategies to reduce reflux on quality of life and on pathological sequelae of reflux in the oesophageal remnant remains to be evaluated.

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Erythromycin Enhances Early Postoperative Contractility of the Denervated Whole Stomach as an Esophageal Substitute

Cited by 43 publications

References 22 publications

Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Reflux after oesophagectomy

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