Document Detail


Manometric study of the lower esophageal sphincter and esophagus in subtotal gastrectomy patients.
MedLine Citation:
PMID:  18269646     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There is controversy in the literature regarding the motor function behavior of the lower esophageal sphincter and esophagus following partial gastrectomy. We studied 26 patients with gastric adenocarcinoma of the distal corpus and/or antrum who underwent radical subtotal gastrectomy with Roux-en-Y reconstruction. There were 15 women (57.69%) and 11 men (42.31%) with a mean age of 57.2 years; 21 were White (80.8%) and five were of African descent (19.2%). Before the surgery and 3 months afterwards, every patient underwent manometric and endoscopic examinations. The lower esophageal sphincter showed reductions in mean respiratory pressure (19.41-15.59 mmHg, P= 0.02) and maximum expiratory pressure (8.13-5.54 mmHg, P= 0.02) without significant alteration in diaphragmatic crura pressure (32.92-30.64 mmHg, P= 0.37). An increase in peristaltic wave amplitude (91.43-124.86 mmHg, P < 0.01) and peristaltic wave conduction velocity (3.29 cm/s to 4.23 cm/s; P= 0.024) were detected in esophageal function. The presence of erosive esophagitis decreased from 10 (38.46%) patients to none (P= 0.002). We concluded that following surgery the lower esophageal sphincter function was impaired, through decreased pressure in the esophageal component without alteration in diaphragmatic crura pressure. On the other hand, there was significant increase in peristaltic wave amplitude and velocity, and improvement of the erosive esophagitis. The authors suggest that subtotal gastrectomy, with gastroesophageal junction preservation, and Roux-en-Y reconstruction should be the preferred operation for distal gastric cancer to minimize esophageal dysfunction and gastroesophageal reflux disease.
Authors:
C A Marcovechio Fonseca; J C Martinez; A Piesciotto; E T Yanagita; O V P Denardin; B Herani Filho
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E     Volume:  21     ISSN:  1442-2050     ISO Abbreviation:  Dis. Esophagus     Publication Date:  2008  
Date Detail:
Created Date:  2008-02-13     Completed Date:  2008-04-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8809160     Medline TA:  Dis Esophagus     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  118-24     Citation Subset:  IM    
Affiliation:
Surgical Oncology Department, Heliópolis Hospital, São Paulo, Brazil. carlosamfonseca@terra.com.br
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Esophageal Sphincter, Lower / physiology*
Female
Gastrectomy*
Humans
Male
Manometry
Middle Aged

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