Preoperative predictability of the short esophagus: endoscopic criteria.
BACKGROUND
Short esophagus is a common cause of failure of antireflux surgery. Minimally invasive intervention for short esophagus is technically difficult. Reliable predictors of short esophagus would allow appropriate referral and better outcomes. The aim of this study is to investigate the preoperative predictability of the short esophagus in patients undergoing antireflux surgery.


METHODS
Eighty-five patients with Collis gastroplasty and antireflux surgery (1994-2007) at a single institution form group A. Control group (B) comprises 205 consecutive patients undergoing primary antireflux surgery (2004-2007). Retrospective review of prospectively collected data was completed. Esophageal length index (ELI) was calculated as the ratio of endoscopic esophageal length (in cm) to height (in meters).


RESULTS
Patients requiring Collis gastroplasty (group A) tend to be older while there were no significant differences in sex, height, weight, and body mass index distribution between groups. Mean endoscopic esophageal length (EEL) as measured from incisor to esophagogastric junction was significantly shorter in group A (32.4 cm) as compared with group B (36.2c m) (p < 0.0001). Esophageal length index (ELI) of less than 19.5 had 83% negative predictive value with 95% specificity.


CONCLUSIONS
Patients with an ELI of less than 19.5 or with stricture have higher risk for having a short esophagus.
Yano
Fumiaki
F
Department of Surgery, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE 68131-2197, USA.
Stadlhuber
Rudolf J
RJ
Tsuboi
Kazuto
K
Garg
Nitin
N
Filipi
Charles J
CJ
Mittal
Sumeet K
SK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult