Endoscopic evaluation of the quality of the anastomosis after esophagectomy with gastric tube reconstruction.
BACKGROUND
The morbidity and mortality of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux continue to burden patients jeopardizing their quality of life. In the present study we performed endoscopic evaluation of the outcomes of esophagogastrostomy by analyzing the presence of anastomotic stenosis and reflux esophagitis.


METHODS
A retrospective analysis was carried out on 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. Fifty-three patients had an endoscopic examination during follow-up (29 +/- 23.6 months, range = 5-111 months). Reflux esophagitis and stenosis at the anastomostic site were analyzed according to the surgical technique used and the location of the esophagogastrostomy.


RESULTS
The mean age at the time of repair was 60.3 +/- 8.87 (range = 39-81) years. Cervical anastomosis was performed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in the frequency of anastomotic stenosis was observed between the two groups (p = 0.829); reflux esophagitis was noted in three patients in the cervical anastomosis group and in 14 patients in the intrathoracic anastomosis group (p = 0.041). For all patients, 23 received a hand-sewn esophagogastric anastomosis and 30 a circular stapled one. There was no significant statistical difference in anastomotic stenosis (p = 0.689) and reflux esophagitis (p = 0.879) in comparisons between the two groups.


CONCLUSIONS
Cervical anastomosis resulted in a better outcome for esophagogastrostomy by lowering the risk of reflux esophagitis; this outcome might improve the patient's quality of life.
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, 97 Guro-Dongkil, Guro-Ku, Seoul 152-703, Korea.
Hyun Koo
HK
Kim
Young Ho
YH
Choi
Jae Hoon
JH
Shim
Yang Hyun
YH
Cho
Man-Jong
MJ
Baek
Young-Sang
YS
Sohn
Hark Jei
HJ
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D004942:Esophagitis, Peptic / Q000209:etiology / Q000517:prevention & control; D004945:Esophagoscopy; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome