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

Abstract

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.

Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through

“…Patients should be closely followed af ter the operation based on the elevated risk for metaplasia, dysplasia and even carcinoma transformation in the esophageal stump [27][28][29] . Some authors opt for chronic use of proton pump inhibitors after esophagectomy to prevent acid esophagitis in the stump [27] .…”

“…Some authors opt for chronic use of proton pump inhibitors after esophagectomy to prevent acid esophagitis in the stump [27] .…”

Comparative Analysis of Late Results of Cervical Esophagogastric Anastomosis by Manual and Mechanical Suture in Patients Submitted to Esophageal Mucosectomy Through Advanced Megaesophagus

“…Although this complication was of low incidence, it needs to be considered due to the possibility of this compromised epithelium evolve to adenocarcinoma, as has already been demonstrated 17 , 27 . Hence, it is important to carry out a long-term follow-up with periodic digestive endoscopies, as recommended in these two patients in our study, or even the prolonged use of proton pump inhibitors to minimize reflux and its complications 24 , 27 .…”

“…Another fact to be remembered is that one patient from each group evolved in the late postoperative period with Barrett’s esophagus in the esophageal stump. This change is usually a consequence of acid reflux and bile of the stomach transposed due to stasis, as has been demonstrated by some authors 24 , 26 , 27 . Although this complication was of low incidence, it needs to be considered due to the possibility of this compromised epithelium evolve to adenocarcinoma, as has already been demonstrated 17 , 27 .…”

Minimally Invasive Laparoscopic Esophagectomy vs. Transhiatal Open Esophagectomy in Achalasia: A Randomized Study

“…As for the surgical time, the open operation was faster and the shortest time was 120 min (mean 170); in the laparoscopy it was 180 min (mean of 227). There was one death in each group related to gastric stasis due to the lack of pyloroplasty 23 , 26 . The fistula index (26%) found no difference between EMIL and ETHA and was similar to the literature (10-26%) 11 , 28 ; was lower in laparoscopy (20%), but without statistical significance.…”