The denervated stomach as an esophageal substitute is a contractile organ.
OBJECTIVE
To determine whether the denervated stomach as an esophageal substitute is an inert conduit or a contractile organ.


BACKGROUND
The motor response of gastric transplants to deglutition suggests that the stomach pulled up to the neck acts as an inert organ.


METHODS
The gastric motility of 11 healthy volunteers and 33 patients having either a gastric tube (GT) (n = 10) or their whole stomach (WS) (n = 23) as esophageal replacement was studied with perfused catheters during the fasting state, after a meal, and after intravenous administration of erythromycin lactobionate. A motility index was established for each period of recording by dividing the sum of the areas under the curves of all contractions of >9 mmHg by the time of recording.


RESULTS
Over years, the denervated stomach recovers more and more motor activity, even displaying a real phase 3 motor pattern in 6 of the 10 WS patients and 1 of the 7 GT patients with >3 years of follow-up. Erythromycin lactobionate generates a phase 3-like motor pattern regardless of the length of follow-up. Extrinsic denervation of the whole stomach does not significantly modify the fasting motility index established >3 years after surgery (+17% on average, p > 0.05), but it reduces that in the fed period by an average of 62% (p = 0.0016). Tubulization of the denervated whole stomach lowers the fasting motility index by an average of 60% (p = 0.0248) and further impairs that in the fed period by an average of 67% (p = 0.0388).


CONCLUSIONS
The denervated stomach as an esophageal substitute is a contractile organ that may even generate complete migrating motor complexes. Motor recovery is better in the fasting than in the fed period, and it is more marked in WS patients than in GT patients.
Collard
J M
JM
Department of Surgery, Louvain Medical School, Brussels, Belgium.
Romagnoli
R
R
Otte
J B
JB
Kestens
P J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003679:Deglutition / Q000502:physiology*; D003714:Denervation; D004935:Esophageal Diseases / Q000601:surgery*; D016629:Esophagectomy; D005215:Fasting; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009043:Motor Activity; D016065:Myoelectric Complex, Migrating / Q000502:physiology; D013270:Stomach / Q000294:innervation / Q000502:physiology* / Q000637:transplantation*; D013997:Time Factors