Motor and electrogastrographic activity of the gastric tube formed after esophagectomy

Abstract

In order to characterize the motor activity of a surgically constructed gastric tube, several hours of ambulatory intraluminal pressure recordings were performed in 6 patients following esophagectomy and gastric tube construction. Whole pressure waves were spectrally analyzed by Fast Fourier Transform (FFT). Simultaneous abdominal and thoracic electrogastrograms (EGGs) were recorded for about 20 min both before and after meals during ambulatory pressure recording. The pressure waves and EGGs for each 20 min recording were analyzed by the maximal entropy method (MEM). While the motility index of the pressure waves decreased after a meal, the 3 cpm component of these waves (2.4-3.7 cpm) increased significantly (n=6, P<0.05). Both bradygastria (0-2.4 cpm) and the duodeno-respiratory component (10-15 cpm) decreased, while the tachygastria component (3.7-10 cpm) increased, although these differences were not significant. The peak power of the gastric tube abdominal EGGs was significantly larger than that of control abdominal or thoracic EGGs in each of the 1 cpm (0-2.4 cpm), 6 cpm (5.0-7.4) and 8 cpm components (7.5-9.9). The thoracic EGG consisted mainly of the 3 cpm component, while the spectral amplitudes of the 1, 6, 8 and 10 cpm components were below 6% of the 3 cpm component. The peak spectral frequency both of the intraluminal pressure waves by FFT and of the thoracic EGGs by MEM occurred within the 3 cpm component. A cross correlation of about 0.2-0.3 occurred between the thoracic EGGs and the intraluminal pressure waves. Thus the gastric tube seems to preserve most of the original gastric motor characteristics and to contribute as a substitute for the original esophagus and stomach.

Impact of the method of reconstruction after oncologic oesophagectomy on quality of life — a prospective, randomised study

“…This is consistent with the results of Tabira et al [19]. This indicated contrarily that although with a small residual gastric volume (a reduction of the gastric capacity by one-third on average after tubulisation, according to Collard et al [21]), the gastric tube well preserved the physiological function of stomach and can function as well as the whole-stomach reconstruction [16].…”

“…(3) After tubulisation, the stomach shows less tendency to dilatation, relieving its compression on the intrathoracic structures [13,14,8]. (4) The gastric tube seems to preserve most of the original gastric motor characteristics, contributing as a good substitute for the original oesophagus and stomach [16]. (5) Acid secretion is suppressed because of the truncal vagotomy and degradation of gastric mucosal blood supply [17,18].…”

Local differences in electrogastrographic indices associated with total gastrectomy, total colectomy, distal gastrectomy and colonic replacement

“…However, due to the large S.E., only the fasting epigastric 3-cpm of ch.5 showed a significantly higher power amplitude than the control (Table 3). The postprandial amplitude increase of the original wave was clearly seen in the control as in the case of the gastric tube (Terashima et al, 2005).…”

“…The original EGG waves before and after TG were presented previously (Homma et al, 1999); however, this is the first study to show the original waves of control, TG, TC, DG and CR subjects as running spectra as in the gastric tube formed after an esophagectomy (Terashima et al, 2005).…”

Esophageal Reconstruction with the Stomach, a Functional Dilemma?

“…Interesting to follow is the modification of gastric motility depending on the diameter of the reconstructive graft (38,39). Thus, strictly comparing the type of reconstructive procedure -whole stomach versus gastric tube -evacuation is delayed in less than 5% of cases in those with gastric tube versus 35-40% when the whole stomach was used.…”