The Study Of Motility Of Remnant Esophagus And Intrathoracic Stomach After Esophagogastrostomy

ObjectiveAt present, surgery plays an important role in the treatment of esophageal cancer,delayed gastric emptying and gastroesophageal reflux usually occurs after the destruction ofthe esophageal hiatus, as well as the resection of the lower esophageal sphincters. It isreported that the location of esophagogastric anastomosis influences the motility of theintrathoracic stomach and the extent of gastroesophageal reflux, however, we found manydifferences in these studies. In this study, we used electrogastrogram, esophagus pressuredetection, endoscopy, upper gastrointestinal radiography, along with reflux symptom toobjectively assess the motility of the remnant esophagus and the intrathoracic stomach, aswell as the extent of gastroesophageal reflux.Materials and MethodsThere were600patients with esophageal carcinoma who received operation in theDepartment of Thoracic surgery from Central Hospital of Tai An and The People’s Hospitalof Fei Cheng between January of2011and January2012.49patients were selectedrandomly, no history of chronic diseases such as hypertention, diabetes, no history of gastricdiseases, no obvious physical distinction. There were37male and12female at the meanage of55years. All of the cases were diagnosed by gastroscope and pathology examination,26patients of them had esophageal carcinoma in the upper and middle third, receivedcervical esophagogastrostomy, while23patients underwent esophagogastrostomy under theaortic arch. The patients were divided into two groups according to the coinciding sites,26patients with neck anastomosis and23patients with anastomosis below the aortic arch. Wechose ten healthy volunteers without digestive tract symptom and other chronic diseases, theaverage age was50. We detected the electrogastrogram of the thoracic stomach3monthsand1year after surgery, as well as the electrogastrogram of normal people, Esophagealintraluminal manometer was performed to observe resting pressure and peristaltic contraction of the remnant esophagus, and intrathoracic stomach. The symptom was gradedand scored by questionnaire of all patients according to the method of DeMeester. Refluxesophagitis was endoscopically diagnosed and was graded and scored by Little classification.And the peristaltic contraction of the intrathoracic stomach was observed by upperalimentary tract radiography using the barium or urografin.Statistical analysisT test was utilized to analyze the gastric electric signals, scores of esophagitis,symptom of gastroesophageal reflux, and pressure parameter of intrathoracic stomach aswell as the remnant esophagus. We used mean+/-standard deviation according to the data,took95%confidence interval as the range of normal value. All statistical analyses wereperformed with the use of SPSS13.0software. Differences were considered to bestatistically significant when the P value was equal to or less than0.05.Results1. Electrogastrogram test results:The Electrogastrogram of the normal control group showed neat rhythm, presentsmooth sine curve. The electrogastric amplitude and frequency of the two groups werelower than the normal groups3months after operation, showed obvious difference(P<0.05),but there were no difference between the two groups(P>0.05).1year later, the electrogastricamplitude and frequency of the two groups went back to normal level, apparently the samewith the control group.2. Heartburn symptoms score:There was no significantly difference between group of anastomosis below aortic archand that of cervical anastomosis3month after surgery (P>0.05). In the group of cervicalanastomosis，significant differences in heart burn score were not seen between3month and1year after surgery (P>0.05)．The symptomatic score of heartburn in group of anastomosisbelow aortic arch was significantly higher than that of cervical anastomosis1year aftersurgery(P <0.05).3. Esophageal manometry results:There was a high pressure zone at the anastomotic orifice where its resting pressurewas significantly higher than that of intrathoracic stomach，and significantly lower than thatof lower esophageal sphincter of the heath control group (P<0.05)．The resting pressure ofremnant esophagus was higher than that of the heath control group(P<0.05)，and was equateto that of intrathoracic stomach (P>0.05). 4. Endoscopy showed:The extent of esophagitis in group of anastomosis below aortic arch was significantlyhigher than that of cervical anastomosis l year after surgery (P <0.05)．However there wasno significant difference in the extent of esophagitis between cervical anastomosis groupand below aortic arch group3month after surgery (P>0.05)．5. Upper alimentary tract radiography using barium or urografin:All of the patients underwent Upper alimentary tract radiography using barium orurografin. The weak motor activity of gastric antrum in intrathoracic stomach was observedby upper alimentary tract roentgenography3month after surgery and gradually recoversover time．Conclusions1. The resting pressure of remnant esophagus and intrathoracic stomach is notinfluenced by the location of esophagogastrostomy. The anastomotic orifice has highpressure zone but often fails to prevent gastroesophageal reflux.2. The contracting pressure of the remnant esophagus is significantly higher than thatof normal control. This is likely compensation that decreases esophagopharyngeal reflux．3. The motor activity of gastic antrum in intrathoracic stomach gradually recovers overtime after esophagectomy for cancer.4. Gastroesophageal reflux is affected by the location of anastomotic orifice, Lowthoracic anastomosis is more likely to be followed by gastroesophageal reflux andesophagitis than high anastomosis.