Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

Gutschow, Christian A.; Collard, Jean-Marie; Romagnoli, Renato; Salizzoni, Mauro; Hölscher, A. H.

doi:10.1097/00000658-200104000-00005

Cited by 99 publications

(101 citation statements)

References 27 publications

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“…The first evidence of normal morphological structural restoration and independence from external inputs is electronomicroscopically identified and confirmed by pH-metric evaluation/ 24h (16,(24)(25)(26).…”

Section: Discussionmentioning

confidence: 84%

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Predescu¹,

Constantinoiu²

2018

chr

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RezumatÎn urmă cu câteva decade, substituţia esofagiană se adresa în special cazurilor de stenoze esofagiene postcaustice; actual, reconstrucţia şi-a lărgit paleta indicaţiei şi pentru alte domenii din patologia esofagiană benignă (tulburări motorii severe, acalazie multi-recidivată, stenoze peptice, etc.) dar a devenit şi un timp final cvasi-obligatoriu în exereza esofagiană pentru cancer ori de câte ori gestul este posibil. Tehnicile de reconstrucţie esofagiană ce folosesc potenţialul visceral al stomacului, indiferent de indicaţie şi varianta tehnică aleasă, rămân o metodă valoroasă şi eficace. O serie de argumente redutabile pledează pentru un tip sau altul de grefon gastric: factori anatomici mai mult decât convenabili (vascularizaţie, lungime suficientă, structură parietală competentă pentru sutură, etc.) şi un act operator sustenabil (durată, abord, complexitate timpi operatori, tulburări digestive post-grefare, funcţionalitate postterapeutică, etc). Opţiunea pentru o tehnică sau alta, dincolo de argumente patologice, trebuie să ţină cont de funcţionalitatea la distanţă, cu evident impact pe status-ul metabolic şi calitatea vieţii. Deci putem argumenta funcţional un montaj gastric sau altul funcţie de acest criteriu? În final, dovada unei rezolvări adecvate este relativ facil de apreciat: a fost restabilită deglutiţia şi dacă da, rezultatul s-a menţinut în timp? Pentru cazurile oncologice evaluarea trebuie să ţină seama şi de criteriul cronologic al ratei de supravieţuire postoperatorii. Metodă: Lotul evaluat statistic s-a întins pe perioada 1981 -2016 şi a cuprins un număr de 268 de pacienţi operaţi pentru stenoze esofagiene, repartizaţi în funcţie de etiopatogenie şi indicaţie în 201 de reconstrucţii pentru cauze stenotice post-caustice şi 67 pentru substituţie post-ablativă de cauză neoplazică. Tehnicile utilizate pentru evaluarea funcţională la distanţă au cuprins: prânz radio-opac, ex.endoscopic + biopsie, iar la cazuri cu modificări evidente pH-metrie/24h şi manometrie şi excepţional scintigrafie cu alimente marcate. Rezultate: Au fost identificate două tipuri de probleme: un tip particular de disfuncţie neuromotorie a substitutului esofagian la 6 pacienţi (1 reconstrucţie tip Gavriliu şi 5 cu tot stomacul Nakayama), evacuarea grefonului fiind dificilă, întârziată, cu stază importantă şi disconfort alimentar (vărsături, inabilitatea alimentaţiei, fenomene aspirative) respectiv o patologie de reflux -8 bolnavi, fiind argumentată de o simptomatologie specifică, de prînzul baritat, de examenul endoscopic şi de examen-ul pH-metric. Refluxul avea un caracter alcalin la 7 pacienţi, toţi cu piloroplastie, 5 cu tot stomacul şi 2 cu procedeu Akiyama iar la 1 caz cu procedeu Gavriliu refluxul era acid. Concluzii: Stomacul este o obţiune redutabilă în substituţia esofagiană. În ceea ce priveşte rezultatele la distanţă se constată o funcţionalitate bună, cu un status metabolic rezonabil. Cele două fenomene de care depinde funcţional grefonul -activitate secretorie şi activitate motorie -par a se restabili odată...

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Section: Discussionmentioning

confidence: 84%

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Predescu¹,

Constantinoiu²

2018

chr

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“…Gutshow et al [11] noted that early after vagotomy intralu minal acidity decreased in two -thirds of the patients, but the stomach recovered its normal pH profile with time. They show that the denervated stomach as an esophageal substitute recovers a normal intralu minal acid ity with time, so that more than 3 years after surgery.…”

Section: Esophageal Exposure To Acid and Duodenal Juicementioning

confidence: 99%

“…The same procedure in relat ion to subtotal esophagectomy may dramatically impair acid s ecretion by the gastric transplant as an esophageal substitute at early follow-up as attested to by the reduction in both basal and peak acid outputs by 83% and 30%, respectively [11]. Theoretically, gastric tubulization should reduce the parietal cell mass , further reducing the acid secretion capacity.…”

Section: Esophageal Exposure To Acid and Duodenal Juicementioning

confidence: 99%

“…Skinner [16] showed that the incidence of esophagitis after esophagectomy was higher than 30% when the stomach was used as a substitute for the esop hagus. Gutshow [11] showed that 38.5% of patients had reflu x esophagitis in the remnant esophagus for three years or more after esophagectomy. Using the Los Angels classification ( Table 1), Shibuya observed sever esophagitis (grade C or D) in 75% o f their patients [17].…”

Section: Reflux Esophagitismentioning

confidence: 99%

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Duodenogastric Reflux after Esophagectomy and Gastric Interposition

Hashimoto¹

2014

OALib

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Stomach is considered the "gold standard" as an esophageal substitute after esophagectomy. Reflux disease is considered an unavoidable consequence of esophageal resection followed gastric interposition. Reflux esophagitis shows a progression from inflammation to erosions and to the development of columnar lined metaplasia. With the use of a gastric interposition, the m ost popular option to reconstruct the esophagus resected for malignant or benign conditions creates an in vivo model of reflux disease. Gastric interposition is far from ideal as an esophageal substitute. R eflux esophagitis and new columnar lined metaplasia should be seen as a new complication of subtotal esophagectomy.

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“…5 Patients who have had an oesophagectomy with gastric pull-up frequently suffer from severe reflux due to the acid secretion in the gastric conduit. 6 Previous studies have shown that up to 35% of patients (at three years) will have oesophagitis, with some developing columnar metaplasia. 7 This therefore has a huge impact when considering the long-term implications of oesophagectomy for those with benign conditions.…”

mentioning

confidence: 99%

Ivor–Lewis oesophagogastrectomy with Roux-en-Y duodenal bypass

Cartwright

Forbat

Botha

2016

annals

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Oesophagectomies and gastrectomies are performed predominantly for the treatment of malignant disease. However, in this case series, we describe three patients with benign disease who had a laparoscopic oesophagogastrectomy with gastroduodenal detachment and Roux-en-Y biliary diversion, and discuss the operative feasibility and consequent patient outcomes. Our aim was to modify the procedure using an established reconstruction already practised in gastric and bariatric surgery, thereby preventing operative sequelae that lead to a poor quality of life (eg reflux oesophagitis and vomiting). During the first postoperative year, our first two patients experienced weight loss, indigestion and lower bowel symptoms with no apparent improvement in gastric function compared with a standard gastric tube pull-up reconstruction. In the longer term, in both patients, the gastric tube interpositions appeared to function well and there was no evidence of gastro-oesophageal reflux disease, delayed gastric emptying or troublesome indigestion. Our third patient, who had lifelong severe reflux symptoms, was eating normally three months after the operation with no need for antacid medication. We therefore conclude that laparoscopic Ivor–Lewis oesophagogastrectomy with Roux-en-Y bypass is a more complex reconstruction with added risks but may in the long term result in better overall outcomes and satisfaction for patients, particularly those with benign disease.

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Denervated Stomach as an Esophageal Substitute Recovers Intraluminal Acidity With Time

Cited by 99 publications

References 27 publications

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

Duodenogastric Reflux after Esophagectomy and Gastric Interposition

Ivor–Lewis oesophagogastrectomy with Roux-en-Y duodenal bypass

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