The esophageal remnant after gastric interposition

Abstract

Gastric interposition is usually considered the reconstruction of choice following esophageal resection. However, a number of reports show that esophagectomy followed by a gastric transplant is associated with poor quality of life and significant reflux esophagitis in the esophageal remnant. The aim of this work is to review the factors affecting the mucosa of the esophageal remnant when using the stomach. A Medline was conducted. Additional references and search pathways were sourced from the references of reviewed articles. Reflux disease is considered an unavoidable consequence of esophageal resection followed by gastric interposition. Mucosal damage from acid and bile exposure in the esophageal remnant affects approximatively 50% of these patients. There is usually no correlation between symptoms and the presence of mucosal damage in the remaining esophagus. Endoscopy and endoscopic biopsies are the only reliable methods to document the status of the mucosa. When present, reflux esophagitis shows a progression from inflammation to erosions and to the development of columnar lined metaplasia. Esophageal and gastric function, gastric drainage operation, level of the anastomosis, route of reconstruction, and patients' position after the operation have all been shown to influence the severity and extent of damage in the esophageal remnant. Prevention and treatment of esophagitis in the remaining esophagus are discussed. When the stomach is used as a substitute to reconstruct the esophagus whether for malignant or benign conditions, an in vivo model of reflux diseases is created. Studies using this model may help clarify molecular and cellular events that lead to irreversible insult on the esophageal mucosa. Improvement to the reconstruction itself must be sought to favor better results with the gastric transplant.

Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer

“…In contrast, postoperative patient‐related variables as independent factors affecting survival have been scarcely suggested. During the postoperative period, several side effects of esophagectomy can merge, including onset of postoperative complications, surgical stress, impaired inflammatory response, and malnutrition as a consequence of gastric volume reduction, delayed food intake, impaired gastric emptying, dysphagia, and reflux 6–9 . The expected end‐results of this multifaceted process can lead to a strong impairment of the immunologic system that may adversely impact on the oncologic outcome 10 .…”

Gastric-tube versus whole-stomach esophagectomy for esophageal cancer: A systematic review and meta-analysis

“…The reduction in gastric acid secretion after gastric-tube reconstruction can effectively prevent the occurrence of reflux esophagitis [23, 24]. (3) The volume of the tubular stomach is smaller than that of the whole stomach (21.4%–47.2% reduction) [25]. Thus, the compression of the stomach by the lungs during coughing or breathing is reduced, which can decrease the duration and amount of reflux [26].…”

SSAT Controversies Intramucosal Esophageal Cancer and High-Grade Dysplasia: Which Treatment?

“…There is no recommendation for surveillance post esophagectomy and reports of a second cancer developing in the cervical esophageal remnant harboring Barrett's are rare. [12][13][14] Alterations in functional outcome after esophagectomy may also be overemphasized. Williams et al in a careful functional analysis of patients following transhiatal esophagectomy for HGD found that the vast majority are doing quite well.…”