Acid-related diseases following retrosternal stomach interposition
Maier, A.; Tomaselli, F.; Sankin, O.; Anegg, U.; Fell, B.; Renner, H.; Pinter, H.; Friehs, G.B.; Smolle-Jüttner, F.M.
Hepato-Gastroenterology 48(39): 899-902
2001
ISSN/ISBN: 0172-6390 PMID: 11462952 Document Number: 532549
Background/Aims: Esophagectomy and reconstruction with retrosternal stomach interposition implies bilateral truncal vagotomy, which supposedly causes gastric functional impairment. Methodology: Esophagectomy and reconstruction with retrosternal stomach interposition was performed on 15 men (mean age: 58.4 years) and 3 women (mean age: 43.6 years). The stomach was pedicled on the right gastric and right gastroepiploic artery without performing pyloroplasty. The cervical side-to-end anastomosis was sutured manually. The functional results were assessed 2-4 years post-operatively, by determining 24-hour qualitative intragastric pH-measurement, fluoroscopical gastric emptying studies, fasting gastrin levels, and endoscopy with biopsy studies. Results: Endoscopy and biopsy confirmed esophagitis in 12 patients, gastritis in 15 and a gastric ulcer in 1 case. Fluoroscopic examination documented a normal passage of contrast medium in 17, slight impairment in 1 case treated by balloon dilatation of the pylorus. Qualitative intragastric pH-measurement revealed a total pH <3 in 22.5-98.05% of measuring events (mean: 74.31%) within 24 hours, in 18 cases. Only 4 patients had pH <3 in less than 50%. Fasting gastrin levels (normal range: 25-110mU/L) varied from 48.78mU/L-168.20 (mean: 85.23mU/L). Only 3 patients had levels >110mU/L (maximum: 168.20mU/L). Conclusions: Acid-related diseases may also occur after truncal vagotomy and retrosternal stomach interposition. Routine follow-up endoscopy and biopsy studies should be done to prevent inflammatory complications and maintain the patient's quality of life.