Publication

Altered esophageal motility and gastroesophageal barrier in patients with jejunal interposition after distal esophageal resection for early stage adenocarcinoma

Journal Paper/Review - Oct 1, 2007

Units
PubMed
Doi

Citation
Linke G, Borovicka J, Tutuian R, Warschkow R, Zerz A, Lange J, Zünd M. Altered esophageal motility and gastroesophageal barrier in patients with jejunal interposition after distal esophageal resection for early stage adenocarcinoma. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2007; 11:1262-7.
Type
Journal Paper/Review (English)
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2007; 11
Publication Date
Oct 1, 2007
Issn Print
1091-255X
Pages
1262-7
Brief description/objective

INTRODUCTION: Limited resection of the esophagogastric junction has been proven to be safe and oncologically radical in patients with early esophageal cancer. Reconstruction with interposition of isoperistaltic jejunal loop (Merendino procedure) is supposed to prevent gastroesophageal reflux and therefore the recurrence of intestinal metaplasia at the anastomosis. The aim of this study was to assess the frequency of acid and nonacid refluxes after Merendino procedure using multichannel intraluminal impedance-pH (MII-pH) monitoring. PATIENTS AND METHODS: Between 2002 and 2005, 12 patients with esophageal adenocarcinoma underwent limited resection and jejunal interposition. Ten patients agreed to undergo a Gastrointestinal Symptom Rating Scale assessment, upper gastrointestinal (GI) endoscopy, esophageal manometry, and combined 24-h MII-pH monitoring more than 10 months postoperatively. RESULTS: Postoperatively, 4 (40%) patients reported belching without heartburn or acid regurgitation, 3 of them having a positive symptom index during 24-h MII-pH monitoring. Upper GI endoscopy revealed no inflammation, metaplasia, or stenosis at the esophagojejunal anastomosis. Esophageal manometry showed ineffective esophageal motility in four of ten patients. Combined 24-h MII-pH monitoring revealed normal distal esophageal acid exposure (% time pH < 4: 0.1% [0-1.5]), normal number of acid reflux episodes (3 [0-11]) but a high number of nonacid reflux episodes (82 [33-184]). Overall, eight patients revealed an abnormal number of nonacid reflux episodes. CONCLUSION: The limited resection with jejunal interposition for early esophageal cancer is efficient in controlling acid but not nonacid reflux. While the clinical relevance of nonacid reflux in the recurrence of Barrett's esophagus is currently unknown, endoscopic surveillance should be considered in these patients.