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Function of the intrathoracic stomach as esophageal replacement

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Abstract

The emptying, acid secretion, mucosal changes, and duodenogastric and gastroesophageal reflux of the intrathoracic stomach were studied in 12 patients together with the clinical course 6–12 months after esophageal replacement.

Although no pyloroplasty had been performed, the emptying of a semisolid meal from the interposed stomach was significantly accelerated compared to the controls. No residual food was found in the stomach at endoscopy after an overnight fast. Distinctly accelerated gastric emptying correlated with spontaneous duodenogastric reflux across the denervated pylorus.

Despite a persistent acid secretion of the vagotomized intrathoracic stomach, no pathologic gastroesophageal reflux and no esophagitis were found proximal to the cervical anastomosis. Gastric biopsies mostly revealed mild gastritis of the antral mucosa, whereas metaplasia was rare. The intrathoracic stomach does not need a drainage procedure to facilitate semisolid emptying. Postoperative reflux esophagitis is prevented by complete intrathoracic stomach transposition with cervical esophagogastrostomy.

Résumé

La vidange, la sécrétion acide, les changements de la muqueuse, et l'importance du reflux duodénogastrique et gastrooesophagien de l'estomac monté dans le thorax pour remplacer l'oesophage ont été étudiés chez 12 patients 6 à 12 mois après leur intervention.

Bien qu'aucune pyloroplastie n'ait été réalisé, la vidange d'un repas semi-solide était accélérée de façon significative par rapport aux contrôles. On n'a trouvé aucun résidu d'aliments dans l'estomac à l'endoscopie après une nuit de jeûne. La vidange gastrique était nettement accélérée et était corrélée avec un reflux duodénogastrique à travers le pylore dénervé.

Malgré la persistance de sécrétion acide dans l'estomac vagotomisé, il n'y avait pas de reflux gastrooesophagien pathologique, ni d'oesophagite en amont de l'anastomose cervicale. Aux biopsie gastriques, on a mis en évidence une gastrite modérée de la muqueuse antrale, alors que la métaplasie était rare. Il n'est pas nécessaire d'effectuer un procédé de drainage de l'estomac monté dans le thorax pour faciliter la vidange gastrique des repas semi-solides. Le reflux oesophagien postopératoire est évité lorsque l'on pratique une transposition thoracique complète de l'estomac avec oesophagogastrostomie cervicale.

Resumen

El vaciamiento, la secreción ácida, los cambios en la mucosa, y el reflujo duodenogástrico y gastroesofágico en el estómago intratorácico fueron estudiados en 12 pacientes, junto con la evolución clínica en los 6–12 meses posteriores al reemplazo esofágico por medio de un estómago intratorácico sin piloroplastia.

Aunque no se realizó piloroplastia, el vaciamiento de una comida semisólida del estómago así interpuesto apareció significativamente acelerado en comparación con los controles. No se detectó residuo alimenticio en el estómago a la endoscopia después de una noche de ayuno. El acelerado vaciamiento gástrico se correlaciona con reflujo gastroduodenal espontáneo a través del píloro denervado.

A pesar de una persistente secreción ácida en el estómago intratorácico vagotomizado, no se encontraron reflujo gastroesofágico patológico ni esofagitis proximal a la anastomosis cervical. Las biopsias gástricas generalmente revelaron gastritis leve en la mucosa antral, pero la metaplasia fue rara. El estómago intratorácico no requiere procedimientos de drenaje para facilitar el vaciamiento de alimentos semisólidos. La gastritis por reflujo postoperatorio puede ser prevenida con la transposición intratorácica total del estómago con esofagogastrostomía cervical.

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References

  1. Akiyama, H., Miyazono, H., Tsurumaru, M., Hashimoto, C., Kawamura, T.: Use of the stomach as an esophageal substitute. Ann. Surg.188:606, 1978

    Google Scholar 

  2. Stelzner, F., Kunath, U.: Ergebnisse bei oesophagointestinalen Anastomosen und Untersuchungen der Durchblutung des dafür mobilisierten Magens. Chirurg48:651, 1977

    Google Scholar 

  3. Siewert, J.R., Adolf, J., Bartels, H., Hölscher, A.H., Hölscher, M., Weiser, H.F.: Oesophaguskarzinom: Transthorakale Oesophagektomie mit regionaler Lymphadenektomie und Rekonstruktion mit aufgeschobener Dringlichkeit. Dtsch. Med. Wochenschr.111:647, 1986

    Google Scholar 

  4. Siewert, J.R., Hölscher, A.H., Becker, K., Gössner, W.: Kardiacarzinom: Versuch einer therapeutisch relevanten Klassifikation. Chirurg58:25, 1987

    Google Scholar 

  5. Heidenreich, P., Vogt, H., Eisenberger, A.S., Wölfle, K.D.: Diagnostik des duodeno-gastralen Reflux mit 99m Tc-HIDA. Methode und Ergebnisse nach selektiver proximaler Vagotomie (SPV) und Pyloroplastik. Der Nuklearmediziner5:83, 1982

    Google Scholar 

  6. Whitehead, R., Truelove, S.C., Bear, M.W.L.: The histological diagnosis of chronic gastritis in fiberoptic gastroscope biopsy specimens. J. Clin. Pathol.25:1, 1972

    Google Scholar 

  7. Elster, R.: Morphologie der Refluxoesophagitis. Langenbecks Arch. Chir.347:267, 1978

    Google Scholar 

  8. Hölscher, A.H., Weiser, H.F.: Reflux characteristics in health and disease. In Gastrointestinal Motility, C. Roman, editor, Lancaster, MTP Press Ltd., 1985, pp. 63–70

    Google Scholar 

  9. Blackwell, J.N., Hannan, W.J., Adam, R.D., Heading, R.C.: Radionuclide transit studies in the detection of oesophageal dysmotility. Gut24:421, 1983

    Google Scholar 

  10. Russell, C.O.H., Hill, E.D., Holmes, III, E.R., Hull, D.A., Gannon, R., Pope, II, C.E.: Radionuclide transit: A sensitive screening test for esophageal dysfunction. Gastroenterology80:887, 1981

    Google Scholar 

  11. Chiba, J., Inoue, Z., Konno, O.: Functions of the substitute for the esophagus after esophageal surgery. Nippon Kyobugeka Gakkai Zasshi (Japan)33:140, 1985

    Google Scholar 

  12. Mori, S., Aboh, T., Watanabe, T.: Long term results after radical operation of thoracic esophageal carcinoma. Geka (Japan)34:927, 1972

    Google Scholar 

  13. Sudo, T., Shiraha, S., Ishiyama, K.: Clinical study on the carbohydrate metabolism and pancreatic endocrine function after esophagectomy. Nippon Syokaki Geka Gakkai Zasshi (Japan)15:1381, 1982

    Google Scholar 

  14. Mannell, A., Hinder, R.H., Sun-Garde, D.H.: The thoracic stomach: A study of gastric emptying, bile reflux, and mucosal change. Br. J. Surg.71:438, 1984

    Google Scholar 

  15. Lam, K.H., Lim, T.K., Wong, J., Ong, G.B.: Changes in metabolism of major food components in patients with intrathoracic replacement of the esophagus with stomach. Br. J. Surg.65:489, 1978

    Google Scholar 

  16. Hinder, R.A.: The effect of posture on the emptying of the intrathoracic vagotomized stomach. Br. J. Surg.63:581, 1976

    Google Scholar 

  17. Angorn, I.W.: Esophago-gastrostomy without a drainage procedure in esophageal carcinoma. Br. J. Surg.62:601, 1975

    Google Scholar 

  18. Collis, J.L.: The long-term clinical state after resection with gastrosophagostomy. In Surgery of the Esophagus, R.A. Smith, R.G. Smith, editors, London, Butterworth, 1972, p. 19

    Google Scholar 

  19. Ellis, F.H., Gibb, S.P.: Esophago-gastrectomy for carcinoma. Current hospital mortality and morbidity rates. Ann. Surg.190:699, 1975

    Google Scholar 

  20. Shapiro, F.: The shape of the pylorus in esophago-antrostomy. Surg. Gynecol. Obstet.135:216, 1972

    Google Scholar 

  21. Su, J.H., Hann, J.F.: Roentgenologic study of gastrointestinal functions after resection for carcinoma of the esophagus and gastric cardia. Tumor Prev. Treat. Study1:9, 1978

    Google Scholar 

  22. Huang, G.J., Zhang, D.C., Zhang, D.W.: A comparative study of resection of carcinoma of the esophagus with and without pyloroplasty. In Esophageal Disorders. Pathophysiology and Therapy, T.R. DeMeester, D.B. Skinner, editors, New York, Raven Press, 1985, pp. 383–388

    Google Scholar 

  23. Cheung, H.C., Siu, K.F., Wong, J.: Is pyloroplasty necessary in esophageal replacement by stomach? A prospective, randomized controlled trial. Surgery102:19, 1987

    Google Scholar 

  24. Okada, N., Nishimura, O., Sakurai, T., Tsuchihashi, S., Juhri, M.: Gastric functions in patients with intrathoracic stomach after esophageal surgery. Ann. Surg.204:114, 1986

    Google Scholar 

  25. Clarke, R.J., Alexander-Williams, J.: The effect of preserving antral innervation and of a pyloroplasty on gastric emptying after vagotomy in man. Gut14:300, 1973

    Google Scholar 

  26. Okada, N., Tagami, Y., Morishita, H., Nishimura, O., Takimoto, M., Kodama, K.: Reconstruction of the esophagus by posterior invagination esophagogastrostomy. World J. Surg.1:361, 1977

    Google Scholar 

  27. Tagami, Y.: Clinical and experimental studies on postoperative functions of esophagogastrostomy in cases of the upper and middle third of intrathoracic esophageal cancer. Wakayama Igaku (Japan)28:33, 1977

    Google Scholar 

  28. Muyshondt, E., Schwartz, S.I.: Vitamin B12 absorption following vagectomy and gastric surgery. Ann. Surg.160:788, 1964

    Google Scholar 

  29. Toskes, P.P., Hansell, J., Cerda, J., Deren, J.J.: Vitamin B12 malabsorption in chronic pancreatic insufficiency. N. Engl. J. Med.284:627, 1971

    Google Scholar 

  30. Baron, J.H.: The rationale of the different operations for peptic ulcer. In Vagotomy on Trial, A.G. Cox, J. Williams, editors, London, Heinemann, 1973, pp. 8–35

    Google Scholar 

  31. Dignan, A.P.: A laboratory appraisal of the effect of truncal and selective vagotomy. Br. J. Surg.57:249, 1970

    Google Scholar 

  32. Feldman, M., Richardson, T., Fordtran, J.S.: Experience with sham feeding as a test for vagotomy. Gastroenterology79:792, 1980

    Google Scholar 

  33. Lam, K.H., Lim, T.K., Wong, J., Lam, S.K., Ong, G.B.: Gastric histology and function in patients with intrathoracic stomach replacement after esophagectomy. Surgery85:283, 1979

    Google Scholar 

  34. Siewert, J.R., Hölscher, A.H.: 20 Jahre Vagotomie: Indikation und Verfahrenswahl-Ulcus duodeni. Zentralbl. Chir.111:953, 1986

    Google Scholar 

  35. Becker, H.D., Reeder, D.D., Thompson, J.C.: Effect of truncal vagotomy with pyloroplasty or with antrectomy on food-stimulated gastrin values in patients with duodenal ulcer. Surgery74:580, 1973

    Google Scholar 

  36. Takeda, H., Fukushima, H., Kakegawa, T.: Functions of the gastric tube and postoperative metabolism in esophageal surgery. Nippon Kyobugeka Gakkai Zasshi (Japan)29:113, 1981

    Google Scholar 

  37. Yonezawa, K., Tsuchiya, S.: The pathophysiology after reconstruction of the esophagus with the gastric tube. Nippon Kyobugeka Gakkai Zasshi (Japan)29:119, 1981

    Google Scholar 

  38. Borst, H.G., Dragojevic, D., Stegmann, T., Hetzer, R.: Anastomotic leakage, stenosis and reflux after esophageal replacement. World J. Surg.2:861, 1978

    Google Scholar 

  39. Little, A.G., Ferguson, M.K., Scott, W.J., Staszak, V.M., Ryan, J.W., Skinner, D.B.: Functional evaluations of organ interposition for esophageal replacement. In International Esophageal Week Munich, September 14–19, 1986. Book of Abstracts, J.R. Siewert, A.H. Hölscher, editors, Munich, Demeter, 1986, p. 107

    Google Scholar 

  40. Pichlmaier, H., Müller, J.M., Wintzer, G.: Oesophagusersatz. Chirurg49:65, 1978

    Google Scholar 

  41. Skinner, D.B.: Invited commentary to Anastomotic leakage, stenosis and reflux after esophageal replacement. World J. Surg.2:861, 1978

    Google Scholar 

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Authors and Affiliations

  1. Departments of Surgery and Nuclear Medicine, Technical University of Munich, Munich, Germany

    Arnulf H. Hölscher M.D., Herbert Voit M.D., Götz Buttermann M.D. & J. Rüdiger Siewert M.D., F.A.C.S.

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  1. Arnulf H. Hölscher M.D.
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  2. Herbert Voit M.D.
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  3. Götz Buttermann M.D.
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  4. J. Rüdiger Siewert M.D., F.A.C.S.
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Hölscher, A.H., Voit, H., Buttermann, G. et al. Function of the intrathoracic stomach as esophageal replacement. World J. Surg. 12, 835–842 (1988). https://doi.org/10.1007/BF01655491

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