[Motility and mucosal hemodynamics of the lower esophagus after transabdominal esophageal transection for esophageal varices].
Lower esophageal motility and mucosal hemodynamics were investigated in 20 patients who underwent transabdominal esophageal transection for esophageal varices (ET), to evaluate their association with reflux esophagitis and variceal recurrence. In the manometric study with microtransducer catheter, maximum swallowing pressure in the lower esophagus of the patients was significantly lower than that of the healthy controls (20 cases) (26.1 +/- 20.5mmHg vs. 80.0 +/- 10.0mmHg: p < 0.01), while high pressure zone pressure did not differ between the two groups. In comparison between patients with and without esophagitis (E(+) and E(-)), maximum swallowing pressure of E(+) was statistically lower than that of E(-) (12.4 +/- 18.7mmHg vs. 31.0 +/- 19.1mmHg: p < 0.05). In the hemodynamic study by reflectance spectrophotometry, the index of esophageal mucosal blood volume (IHb) and the index of oxygen saturation of hemoglobin (ISo2) of E(+) and E(-) were no different from those in the patients with non-operated esophageal varices (10 cases). Although there was no correlation between the recurrence of RC-sign and mucosal microcirculation, the patients with larger varices tended to have a higher IHb and a patients with F1-varices had significantly lower ISo2 than the patients without varices. This study indicated that the poor clearance ability after ET may lead to reflux esophagitis and the patients with variceal recurrence had the congested mucosal microcirculation, compared to those without variceal recurrence.
Tamura
S
S
Department of Surgery II, Osaka University Medical School, Japan.
Shiozaki
H
H
Kobayashi
K
K
Tahara
H
H
Miyata
M
M
Oka
H
H
Mori
T
T
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000503:physiopathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000098:blood supply / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D009068:Movement; D009092:Mucous Membrane / Q000098:blood supply; D011312:Pressure