Functional assessment of the cervical esophagus after gastric transposition and cervical esophagogastrostomy.
OBJECTIVE
The aim of this exploratory study was to investigate swallowing and function of the cervical esophagus after esophageal resection and reconstruction.


METHODS
Nine patients (8 males, 1 female; median age 63 years), who underwent esophageal resection for adenocarcinoma, were studied from 6 to 40 months (median 18 months) postoperatively. For all patients, the upper gastrointestinal tract was reconstructed by transposing a narrow gastric tube through the posterior mediastinum to the left neck, where a semi-mechanical anastomosis to the cervical esophagus was performed. No patient had an anatomic obstruction to swallowing or stricture. The oral and pharyngeal phases of deglutition and function of the cervical esophagus were evaluated objectively by video barium swallow, esophagogastroscopy, velopharyngeal examination, manometry and balloon inflation in the cervical esophagus.


RESULTS
The median length of the cervical esophagus was 5 cm (range 3-7 cm). Mild reflux laryngopharyngitis was seen in all patients. Although all patients had an objective functional dysphagia measurement (American Speech-Language-Hearing Association) of 7 (normal), five reported subjective dysphagia. Four (of the five symptomatic) patients were found to have high pressure peristalitic activity (mean >100 mmHg) following balloon distention (10-30 ml) of the cervical esophagus, which was painful in three cases.


CONCLUSIONS
We conclude that in the absence of an anatomic cause for dysphagia after cervical esophagogastrostomy, a functional etiology may be explained by hypertensive peristalsis resulting from distention of the remaining cervical esophageal remnant. These findings may further explain anecdotal reports of the efficacy of empiric dilation after upper gastrointestinal reconstruction when no stricture is seen.
Koh
Paul
P
Dalhousie University, Halifax, NS, Canada.
Turnbull
Geoffrey
G
Attia
Elhamy
E
LeBrun
Paul
P
Casson
Alan G
AG
D000230:Adenocarcinoma / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis; D011183:Postoperative Complications / Q000503:physiopathology; D012720:Severity of Illness Index; D013270:Stomach / Q000601:surgery