Document Detail

Altered esophageal motility and gastroesophageal barrier in patients with jejunal interposition after distal esophageal resection for early stage adenocarcinoma.
MedLine Citation:
PMID:  17624578     Owner:  NLM     Status:  MEDLINE    
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.
Georg R Linke; Jan Borovicka; Radu Tutuian; Rene Warschkow; Andreas Zerz; Jochen Lange; Michael Zünd
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Publication Detail:
Type:  Journal Article     Date:  2007-07-12
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  11     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-12     Completed Date:  2007-12-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1262-7     Citation Subset:  IM    
Department of Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
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MeSH Terms
Adenocarcinoma / surgery*
Digestive System Surgical Procedures / methods
Esophageal Neoplasms / surgery*
Gastrointestinal Motility / physiology*
Jejunum / transplantation*
Lymph Node Excision
Reconstructive Surgical Procedures

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