Mucosal damage in the esophageal remnant after esophagectomy and gastric transposition.
OBJECTIVE
To assess development of mucosal damage in the esophageal remnant in regard to the level of the esophagogastrostomy reconstruction either in a right chest or in a left neck position.


BACKGROUND
Esophagectomy with gastric interposition creates an in vivo human model of pathologic esophageal reflux with the potential for long-term reflux disease complications.


METHODS
Eighty-four esophagectomy patients were assessed over time by symptoms, endoscopy and biopsies of their esophageal remnant after the operation. The anastomosis was in the right upper chest (n = 36) or in a left cervical position (n = 48). Visual quantification of damage, details of histopathology, and time period since surgery were recorded.


RESULTS
Twenty-nine patients (81%) with a right chest reconstruction had reflux symptoms when compared with 25 patients (53%) with a neck reconstruction (P = 0.007). Visualized reflux esophagitis was observed in 31 patients (81%) with chest anastomoses and in 22 patients (46%) with cervical anastomoses (P = 0.006). Documented mucosal damage and columnar lined metaplasia were significantly more frequent in the chest anastomosis group than the cervical group. The median of all mucosal damage and columnar lined metaplastic-free evolution were 13 +/- 3 and 20.5 +/- 6 months for the intrathoracic anastomosis, and 22 +/- 6 months and 40 +/- 8 months for the cervical anastomosis (P = 0.087). Two factors affecting the development of metaplasia were included in the multivariate analysis: an intrathoracic anastomosis (P = 0.018) and the presence of a previous Barrett esophagus (P = 0.064).


CONCLUSIONS
When a gastric transplant is used after esophagectomy, a high prevalence of mucosal damage is observed in the esophageal remnant independently of the level of reconstruction. A left cervical anastomosis favors less reflux symptoms, less visualized damage, and delays the development of mucosal damage over time.
D'Journo
Xavier Benoit
XB
Departments of Surgery and Pathology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
Martin
Jocelyne
J
Rakovich
Georges
G
Brigand
Cecile
C
Gaboury
Louis
L
Ferraro
Pasquale
P
Duranceau
André
A
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001706:Biopsy; D016629:Esophagectomy / Q000009:adverse effects*; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries; D013270:Stomach / Q000637:transplantation*