Reflux esophagitis and columnar-lined esophagus after cervical esophagogastrostomy (following esophagectomy)

Abstract

Reflux esophagitis (RE) and columnar-lined esophagus (CLE) are frequently observed after esophagectomy. The incidence of these conditions according to time and to the route of esophageal reconstruction after esophagectomy remains unknown. The aim of this study was to clarify any changes and differences of the incidence of RE and CLE in patients who underwent gastric tube reconstruction after esophagectomy. A hundred patients who underwent cervical esophagogastrostomy after resection of the thoracic esophagus were included in this study. We reviewed their endoscopic findings at 1 month, at 1 year and at 2 years after surgery, and compared the incidence rates of RE and CLE with the passage of time and among the three reconstruction routes; a subcutaneous route, a retrosternal route, and a posterior mediastinal route. The incidence rate of RE was 42%, 37% and 38%, at 1 month, 1 year and at 2 years after surgery, respectively. There was no significant difference in the incidence of RE according to the time after surgery. The incidence rate of severe RE (Grade C and D in the Los Angeles Classification) was 9% percent at 1 month after surgery, 18% at 1 year after surgery and 22% at 2 years after surgery, significantly increasing with passage of time. The incidence rate of CLE was 0% at 1 month after surgery, 14% at 1 year after surgery and 40% at 2 years after surgery, significantly increasing with passage of time. No difference was observed in the incidence of RE and that of CLE among the three routes of esophageal reconstruction. Severe RE and CLE increase with passage of time after cervical esophagogastrostomy. Therefore, careful endoscopic follow-up is necessary for such patients irrespective of the route of esophageal reconstruction.

Reflux esophagitis after esophagectomy: impact of duodenogastroesophageal reflux

“…RE is often seen in patients who have undergone esophagogastrostomy after esophagectomy, and affects the quality of life in those patients 3,4,7,8,13,14 . The incidence of RE after esophagectomy was reported as 71.6% by Shibuya et al ., 3 as 58.3% by Yamamoto et al ., 4 as 32.1% by Kim et al ., 13 and as 45.9–70.0% by da Rocha et al 14 .…”

“…Recently, several reports have shown a correlation between acid and/or bile reflux, and RE or Barrett's esophagus after esophagectomy 3–7 . We have previously reported that 42% of patients developed RE at 1 month after esophagectomy 8 . However, the influence of acid and/or bile reflux and other clinical factors on RE is still unclear.…”

Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review

“…A Japanese study published in 2010 predominantly considered reflux esophagitis in the esophageal remnant, but some data on columnar metaplasia is included . Data were available for 100 patients at 1 year, and a 14% prevalence of metaplasia is quoted.…”

“…Four studies evaluated the association between time from surgery and the presence of Barrett's‐like metaplasia . Nishimura and colleagues, in their study of 100 patients, describe no cases of columnar metaplasia at 1 month, 14% prevalence at 1 year, and 40% prevalence in a subgroup of 58 patients who were followed up for 2 years . The other study which reports a significant association between the time from surgery and the presence of columnar metaplasia is that of da Rocha and colleagues .…”

“…On multivariate analysis, thoracic anastomosis was associated with a significantly greater risk of developing postoperative Barrett's (odds ratio 3.05, P = 0.018). The second study to consider the route of reconstruction as a risk factor was that undertaken by Nishimura and colleagues . This study compared the subcutaneous, retrosternal and posterior mediastinal routes of reconstruction, but all patients are described as having a cervical esophagogastrostomy and the surgical methods are not described in detail.…”