Reflux Esophagitis and Development of Ectopic Columnar Epithelium in the Esophageal Stump After Gastric Transposition: A Prospective Study

  • I. Cecconello
  • J. Mariano Da Rocha
  • B. Zilberstein
  • V. Felix
  • H. W. Pinotti
Conference paper


Fifty-eight consecutive cases submitted to esophagectomy and gastric transposition because of advanced achalasia were followed prospectively. All patients underwent endoscopy and acid secretion studies both pre- and post-operatively (6 and 48 months after resection). Esophagitis was observed in 7 cases after 6 months (15.9%) and 24 cases at the second evaluation (41.3%). Of these, 12 complained of heartburn (50%). In 4 of the 58 cases (7%), ectopic columnar epithelium ranging in length from 1.5 to 3.0 cm was observed in the esophageal stump. An ulcer was present in one case and intestinal metaplasia was diagnosed in another. All subjects were treated clinically with continuous antacid therapy, mandatory in 8 cases. Regurgitation and bile in the transposed stomach were noted frequently (50%) in cases with and without esophagitis. Regarding preoperative status, basal and stimulated acid output decreased in the first p.o. evaluation but increased over the long term, and higher mean levels were observed in the group with esophagitis. In conclusion, reflux esophagitis was found to occur even after high anastomoses positioned above the aortic arch. Furthermore, as the period of observation increases, the incidence and intensity of reflux esophagitis rise due to greater exposure of the stump to reflux, regurgitation, and the constant presence of bile and progressively higher acid output in the transposed stomach. Endoscopic follow-up is mandatory because of the possibility of developing ectopic columnar epithelial lining. Lastly, employment of the stomach after esophagectomy is not contraindicated by esophagitis.


Intestinal Metaplasia Gastric Acid Secretion Reflux Esophagitis Esophagogastric Anastomosis Cervical Anastomosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ferreira-Santos R (1963) Surgical treatment of aperistalsis of the esophagus (in Portuguese). Ribeirao Preto, Thesis, Sao Paulo University Medical SchoolGoogle Scholar
  2. 2.
    Ferreira EAB (1975) Subtotal esophagectomy and posterior transmediastinal esophagogastroplasty without thoracotomy in the treatment of megaesophagus (in Portuguese). Thesis, Sao Paulo University Medical SchoolGoogle Scholar
  3. 3.
    Pinotti HW (1977) Transmediastinal subtotal esophagectomy without thoracotomy (in Portuguese). AMB Rev Assoc Med Bras 23: 395PubMedGoogle Scholar
  4. 4.
    Pinotti HW, Zilberstein B, Pollara WM, Raia AA (1981) Esophagectomy without thoracotomy. Surg Gynecol Obstet 152: 344–346PubMedGoogle Scholar
  5. 5.
    Pinotti HW, Cecconello I, Mariano da Rocha J, Zilberstein B (1991) Resection for achalasia of the esophagus. Hepatogastroenterology 38: 470–473PubMedGoogle Scholar
  6. 6.
    Mariano-da-Rocha J (1986) Surgical treatment of the advanced megaesophagus by subtotal esophagectomy associated with gastroplasty: Clinical evaluation and study of the gastric acid secretion and levels of serum pepsinogen and gastrin (in Portuguese). Thesis, Sao Paulo University Medical SchoolGoogle Scholar
  7. 7.
    Cecconello I, Mariano da Rocha JR, Pollara WM, Zilberstein B, Pinotti HW (1988) Long- term evaluation of gastroplasty in achalasia. In: Siewert JR, Holscher AH (eds) Diseases of the esophagus. Springer, Berlin Heidelberg New York, pp 975–979Google Scholar
  8. 8.
    Holscher AH, Voit H, Buttermann G, Siewert JR (1988) Function of the intrathoracic stomach as esophageal replacement. World J Surg 12: 835PubMedCrossRefGoogle Scholar
  9. 9.
    Mariano da Rocha JR, Cecconello I, Sallum RAA, Sakai P, Zilberstein B, Pinotti HW (1991) Barrett esophagus in the esophageal stump, after subtotal esophagectomy with cervical esophagogastroplasty (in Portuguese). ABCD Arq Bras Cir Dig 6 [Suppl 2]: 20Google Scholar
  10. 10.
    Okada N, Nishimura O, Sakurai T, Tsuchihashi S, Juhri M (1986) Gastric functions in patients with intrathoracic stomach after esophageal surgery. Ann Surg 204: 144CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1993

Authors and Affiliations

  • I. Cecconello
  • J. Mariano Da Rocha
  • B. Zilberstein
  • V. Felix
  • H. W. Pinotti
    • 1
  1. 1.Digestive Surgery DivisionSão Paulo University Medical SchoolBrazil

Personalised recommendations