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Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition.

Abstract：

OBJECTIVE:To assess development of mucosal damage in the esophageal remnant in regard to the level of the esophagogastrostomy reconstruction either in a right chest or in a left neck position. SUMMARY BACKGROUND DATA:Esophagectomy with gastric interposition creates an in vivo human model of pathologic esophageal reflux with the potential for long-term reflux disease complications. METHODS:Eighty-four esophagectomy patients were assessed over time by symptoms, endoscopy and biopsies of their esophageal remnant after the operation. The anastomosis was in the right upper chest (n = 36) or in a left cervical position (n = 48). Visual quantification of damage, details of histopathology, and time period since surgery were recorded. RESULTS:Twenty-nine patients (81%) with a right chest reconstruction had reflux symptoms when compared with 25 patients (53%) with a neck reconstruction (P = 0.007). Visualized reflux esophagitis was observed in 31 patients (81%) with chest anastomoses and in 22 patients (46%) with cervical anastomoses (P = 0.006). Documented mucosal damage and columnar lined metaplasia were significantly more frequent in the chest anastomosis group than the cervical group. The median of all mucosal damage and columnar lined metaplastic-free evolution were 13 +/- 3 and 20.5 +/- 6 months for the intrathoracic anastomosis, and 22 +/- 6 months and 40 +/- 8 months for the cervical anastomosis (P = 0.087). Two factors affecting the development of metaplasia were included in the multivariate analysis: an intrathoracic anastomosis (P = 0.018) and the presence of a previous Barrett esophagus (P = 0.064). CONCLUSIONS:When a gastric transplant is used after esophagectomy, a high prevalence of mucosal damage is observed in the esophageal remnant independently of the level of reconstruction. A left cervical anastomosis favors less reflux symptoms, less visualized damage, and delays the development of mucosal damage over time.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

D'Journo XB,Martin J,Rakovich G,Brigand C,Gaboury L,Ferraro P,Duranceau A

doi

10.1097/SLA.0b013e31818eec06

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

262-8

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-200902000-00014

journal_volume

249

pub_type

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Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition.