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Journal of Gastrointestinal Surgery

Published in:

01-10-2007

Altered Esophageal Motility and Gastroesophageal Barrier in Patients with Jejunal Interposition After Distal Esophageal Resection for Early Stage Adenocarcinoma

Authors: Georg R. Linke, Jan Borovicka, Radu Tutuian, Rene Warschkow, Andreas Zerz, Jochen Lange, Michael Zünd

Published in: Journal of Gastrointestinal Surgery | Issue 10/2007

Abstract

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.

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Title: Altered Esophageal Motility and Gastroesophageal Barrier in Patients with Jejunal Interposition After Distal Esophageal Resection for Early Stage Adenocarcinoma
Authors: Georg R. Linke
Jan Borovicka
Radu Tutuian
Rene Warschkow
Andreas Zerz
Jochen Lange
Michael Zünd
Publication date: 01-10-2007
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 10/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-007-0213-0

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Altered Esophageal Motility and Gastroesophageal Barrier in Patients with Jejunal Interposition After Distal Esophageal Resection for Early Stage Adenocarcinoma

Abstract

Introduction

Patients and Methods

Results

Conclusion

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Abstract

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