Function of the intrathoracic stomach as esophageal replacement

Abstract

The emptying, acid secretion, mucosal changes, and duodenogastric and gastroesophageal reflux of the intrathoracic stomach were studied in 12 patients together with the clinical course 6–12 months after esophageal replacement. Although no pyloroplasty had been performed, the emptying of a semisolid meal from the interposed stomach was significantly accelerated compared to the controls. No residual food was found in the stomach at endoscopy after an overnight fast. Distinctly accelerated gastric emptying correlated with spontaneous duodenogastric reflux across the denervated pylorus. Despite a persistent acid secretion of the vagotomized intrathoracic stomach, no pathologic gastroesophageal reflux and no esophagitis were found proximal to the cervical anastomosis. Gastric biopsies mostly revealed mild gastritis of the antral mucosa, whereas metaplasia was rare. The intrathoracic stomach does not need a drainage procedure to facilitate semisolid emptying. Postoperative reflux esophagitis is prevented by complete intrathoracic stomach transposition with cervical esophagogastrostomy.

Disturbed Enterogastric Inhibitory Reflex after Esophageal Resection and Narrow Gastric Tube Reconstruction

“…In some studies, in which the whole stomach or a wide gastric tube (stomach minus cardia) was interposed, delayed gastric emptying was found [28, 29, 30], although this could not be confirmed by other studies [9, 21, 23, 24, 31, 32]. Our data suggest a wide inter-patient variation in gastric emptying rate of solid food as well as in half emptying time of liquid food in comparison with healthy volunteers (own historical control group with same dual isotope scintigraphic technique, without enteral feeding: n = 16; median GER 32, range 25–42%/h; median T½ 24.5, range 7–62 min; unpublished data).…”

Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

“…Thus, a positive Congo red test was found to be more common in patients with more than 5 years of follow-up than in those investigated earlier. 4 Likewise, comparison of data from two series of gastric transplant patients 2,3 indicates that the prevalence of cervical heartburn and endoscopic inflamma-tion in the esophageal remnant on the one hand and exposure of the latter to acid on the other are higher in patients with more than 1 year of follow-up than in those studied 6 to 12 months after surgery. Moreover, according to the well-known functional parallelism between the submucous and myenteric plexuses of the stomach, 5 the spontaneous motor recovery process we have found in the denervated whole stomach as an esophageal substitute 6,7 also bears out the hypothesis that acid secretion may recover with time.…”

“…1 The same procedure in relation to subtotal esophagectomy may dramatically impair acid secretion by the gastric transplant as an esophageal substitute at early follow-up, as attested to by the reduction in both basal and peak acid outputs by 83% and 30%, respectively. 2 However, early postoperative 24-hour intragastric pH monitoring 3 identifies two distinct populations with respect to residual intraluminal acidity: one category of patients who retain substantial intraluminal acidity and another one with hypoacidity. In addition, there is evidence for spontaneous recovery of acid production by the denervated gastric wall over time.…”

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

“…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.…”