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Ľestomac intrathoracique après œsophagectomie partielle ou subtotale sans thoracotomie: aspect endoscopique, enregistrement continu du pH, évaluation tomodensitométrique computée Résultats préliminaires

The intrathoracic stomach after partial and subtotal esophagectomy without thoracotomy: endoscopic appearance, continuous pH-measurement and CT-evaluation Preliminary results

  • Published:
Acta Endoscopica

Résumé

La présente étude réunit les données de ľendoscopie, des biopsies gastriques, des mesures de pH intra-gastrique et des examens en tomographie computée chez 11 patients ayant subi une œsophagectomie partielle ou subtotale avec estomac intrathoracique pour cancer de ľ œsophage ou de la jonction œso-gastrique. Ľobservation endoscopique dominante est une rétention marquée des solides en ľabsence ďobstruction mécanique au niveau du pylore. 5 des 11 patients présentment une œsophagite à ľexamen endoscopique, 5 sur les 8 patients investigués présentaient une gastrite chronique active modérée ou sévère. Les enregistrements continus de pH chez 4 patients ont révélé des valeurs supérieures à 4. Les examens au TC ont été réalisés chez 7 patients et la supériorité du TC sur ľendoscopie dans la détection des récidives tumorales post-opératoires est clairement démontrée pour cette localisation. La vagotomie complète associée à ľ œsophagectomie sans thoracotomie provoque une diminution notable de ľacidite gastrique et une prophylaxie des complications peptiqnes au niveau de ľestomac intra-thoracique. Elle est également la cause principale ďun retard de vidange gastrique des solides confirmee par ľendoscopie chez 8 patients sur 11. Ľeffet bénéfique ďun procéde de drainage pylorique sur ľévacuation gastrique est rejeté pour des raisons physio-pathologiques.

Summary

This report gives a clinicopathologic synopsis of the endoscopic appearance, histologic findings, intragastric pH-levels and CT features of 11 patients with partial or subtotal esophagectomy without thoracotomy for carcinoma of the esophagus or esophagogastric junction. A dominating endoscopic feature was a striking gastric retention of solid foods without evidence of anatomic pyloric obstruction. 5 of 11 patients had macroscopic esophagitis, and 5 of 8 patients investigated in this regard had moderate to severe chronic active gastritis. Continuous pH-measurement in 4 patients revealed constant pH values above 4. CT scans were performed in 7 patients and they were clearly superior to endoscopy in the detection of postoperative tumor recurrence, which was predominantly of extraluminal location. Complete vagotomy inherent to « blunt » esophagectomy provides a substantial reduction of gastric acid concomitant with an effective prophylaxis of potentially hazardous peptic complications of the intrathoracic stomach. It also appears to be the prime factor in causing a markedly delayed gastric emptying of solid foods as confirmed by endoscopy in 8 out of 11 patients. Pathophysiologic considerations question the value of pyloric drainage procedures to facilitate gastric emptying.

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Authors and Affiliations

  1. Dept. of Medicine, Saint-Josef Hospital, Ruhr-University, Bochum, F.R.G.

    M. Wegener, G. Börsch, U. Finke, J. Brandt & V. Zumtobel

  2. Dept. of Surgery, Saint-Josef Hospital, Ruhr-University, Bochum, F.R.G.

    M. Wegener, G. Börsch, U. Finke, J. Brandt & V. Zumtobel

  3. Dept. of Radiology, Saint-Josef Hospital, Ruhr-University, Bochum, F.R.G.

    M. Wegener, G. Börsch, U. Finke, J. Brandt & V. Zumtobel

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  2. G. Börsch
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Wegener, M., Börsch, G., Finke, U. et al. Ľestomac intrathoracique après œsophagectomie partielle ou subtotale sans thoracotomie: aspect endoscopique, enregistrement continu du pH, évaluation tomodensitométrique computée Résultats préliminaires. Acta Endosc 17, 201–210 (1987). https://doi.org/10.1007/BF02968812

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