High Incidence of Reflux Esophagitis Observed by Routine Endoscopic Examination after Gastric Pull‐up Esophagectomy

Abstract

A gastric tube has been widely used for reconstruction of the esophagus after esophagectomy for esophageal cancer. Reflux esophagitis after esophagectomy is frequently observed. Therefore we retrospectively investigated the risk factors for reflux esophagitis after gastric pull-up esophagectomy in 74 outpatients with thoracic esophageal cancer. Reflux esophagitis was diagnosed endoscopically. Esophagitis was classified according to the Los Angeles classification. Reflux symptoms, medications, and the surgical procedure were reviewed. The relation between reflux symptoms and reflux esophagitis and the influence of the anastomotic site were evaluated. Reflux esophagitis was observed in 53 patients. Severe esophagitis (grade C or D) was found in 75.6% of these patients. Although all patients with esophagitis took antacid agents, histamine receptor-2 blocker was effective in only 35% of them. The correlation between reflux symptoms and reflux esophagitis was not significant. Reflux esophagitis was present in 56.4% of patients with neck anastomosis and in 88.6% of patients with intrathoracic anastomosis ( p = 0.0039). We concluded that routine endoscopic examination is necessary after gastric pull-up esophagectomy because reflux esophagitis is not diagnosed based on reflux symptoms. When a gastric tube is used for reconstruction after esophagectomy, neck anastomosis is recommended to lower the risk of reflux esophagitis.

The psychological impact of symptoms related to esophagogastric cancer resection presenting in primary care: A national linked database study

“…For instance, the prevalence of reflux symptoms after esophagectomy in prospective studies ranged from 20-80% with documented 6 endoscopic evidence of reflux esophagitis in 23-72%, compared with 10.7% in our study. [12][13][14][15][16][17] Dumping after esophagectomy was reported in prospective studies at a 8 rate of 78% compared with 6% recorded in primary care. 18 Steatorrhea was recorded in primary care in 0.2% of patients while in other series it was as high as 70%.…”

Esophagectomy with gastroplasty in advanced megaesophagus: late results of omeprazole use

“…We conducted esophagectomy with enlarged proximal gastrectomy (gastric tube) and yearly endoscopy, as experts recommend. We noted that Group A, which was devoid of PPI, showed a greater number of complications due to acid and bile reflux 25,27,28,40 . In addition, our statistical calculations emphasize the use of omeprazole (Group C) as the most significant independent variable correlated with reduced complications of mixed reflux (erosive esophagitis and Barrett's esophagus -Group A) in the univariate analysis, showing a statistically significant difference (Table 2).…”

“…We stress the utmost importance of the clinical follow-up and annual endoscopic exam of patients undergoing esophagogastroplasty, combined with the continued use of proton pump inhibitors, beginning in the early postoperative period in an attempt to decrease tumor development in the remaining esophageal stump 26,33,35,[40][41][42][43] . The results obtained in this study, with 50 Chagas megaesophagus patients, support the conclusion that the use of omeprazole (40 mg/day) reduced the onset of erosive esophagitis and Barrett's esophagus during the late postoperative period.…”

“…The use of proton pump inhibitor was done at a dose of 40 For the descriptive analysis, we used position measurements for continuous variables and frequency for categorical variables. For comparison groups and times of endoscopy results we used the GEE model (Generalized Estimating Equation Model).…”

Duodenogastric Reflux after Esophagectomy and Gastric Interposition

“…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]. In another series of 48 patients , Yamamoto [18] found reflu x esophagitis in 27 o f their 48 patients (56.3%) and majority (70%) had a Los Angeles C or D damage.…”