Document Detail

Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition.
MedLine Citation:
PMID:  19212180     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess development of mucosal damage in the esophageal remnant in regard to the level of the esophagogastrostomy reconstruction either in a right chest or in a left neck position. SUMMARY BACKGROUND DATA: Esophagectomy with gastric interposition creates an in vivo human model of pathologic esophageal reflux with the potential for long-term reflux disease complications. METHODS: Eighty-four esophagectomy patients were assessed over time by symptoms, endoscopy and biopsies of their esophageal remnant after the operation. The anastomosis was in the right upper chest (n = 36) or in a left cervical position (n = 48). Visual quantification of damage, details of histopathology, and time period since surgery were recorded. RESULTS: Twenty-nine patients (81%) with a right chest reconstruction had reflux symptoms when compared with 25 patients (53%) with a neck reconstruction (P = 0.007). Visualized reflux esophagitis was observed in 31 patients (81%) with chest anastomoses and in 22 patients (46%) with cervical anastomoses (P = 0.006). Documented mucosal damage and columnar lined metaplasia were significantly more frequent in the chest anastomosis group than the cervical group. The median of all mucosal damage and columnar lined metaplastic-free evolution were 13 +/- 3 and 20.5 +/- 6 months for the intrathoracic anastomosis, and 22 +/- 6 months and 40 +/- 8 months for the cervical anastomosis (P = 0.087). Two factors affecting the development of metaplasia were included in the multivariate analysis: an intrathoracic anastomosis (P = 0.018) and the presence of a previous Barrett esophagus (P = 0.064). CONCLUSIONS: When a gastric transplant is used after esophagectomy, a high prevalence of mucosal damage is observed in the esophageal remnant independently of the level of reconstruction. A left cervical anastomosis favors less reflux symptoms, less visualized damage, and delays the development of mucosal damage over time.
Xavier Benoit D'Journo; Jocelyne Martin; Georges Rakovich; Cecile Brigand; Louis Gaboury; Pasquale Ferraro; André Duranceau
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  249     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-12     Completed Date:  2009-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  262-8     Citation Subset:  AIM; IM    
Departments of Surgery and Pathology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
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MeSH Terms
Aged, 80 and over
Anastomosis, Surgical
Esophagectomy / adverse effects*
Esophagus / injuries,  pathology*,  surgery*
Middle Aged
Mucous Membrane / injuries
Stomach / transplantation*

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