Risk factors of reflux esophagitis in the cervical remnant following esophagectomy with gastric tube reconstruction.
BACKGROUND
The risk factors and suitable treatment of reflux esophagitis (RE) of the cervical remnant in patients undergoing radical esophagectomy remain unclear. The aim of this study was to evaluate the risk factors in patients with RE in the cervical remnant.


METHODS
We retrospectively examined 141 consecutive patients who underwent esophagectomy and reconstruction with gastric tubing. RE was diagnosed by upper gastrointestinal endoscopy and graded according to the Los Angeles Classification. Statistically, 11 potential risk factors of RE were evaluated. The postoperative follow-up time ranged from 18 to 204 months (median 60 months).


RESULTS
Among a total of 141 patients, 48 (34%) had RE in the cervical remnant, with 14 (29%) cases categorized as grade B, nine (19%) as grade C, and 25 (52%) as grade D. The cumulative incidence of RE in the cervical remnant was 24% at 5 years after surgery and 60% at 10 years, respectively. Pyloroplasty and bile reflux were identified as independent risk factors of RE in the cervical remnant by univariate and multivariate analyses.


CONCLUSIONS
The results of this study show a high incidence and high grade of RE in the cervical remnant after esophagectomy. Routine endoscopic examination and suitable medication is required for the control of RE in the cervical remnant together with surgical procedures to avoid bile reflux.
Yajima
Kazuhito
K
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori 1-757, Niigata, 951-8510, Japan.
Kosugi
Shin-Ichi
S
Kanda
Tatsuo
T
Matsuki
Atsushi
A
Hatakeyama
Katsuyoshi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D016629:Esophagectomy / Q000379:methods*; D004942:Esophagitis, Peptic / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000637:transplantation; D013997:Time Factors