OBJECTIVE: To investigate the possible anti-reflux function of esophagogastric anastomosis in the patients after receiving resection of cardiac cancer. METHODS: One hundred and ninety-two patients were studied by video-assisted gastroscopy, manometry, 24-h pH esophageal monitoring, radioscintigraphy and scanning electron microscopy. RESULTS: Abnormalities were found in 90.2% of patients through endoscopy. Resting pressure in esophageal body was higher than that in normal controls, and in the stomach, lower. Twenty-four hour pH monitoring demonstrated that gastroesophageal reflux (GER) did not occur when the patients slept in semi-reclining position, and occurred in all patients when slept in supine position. Scintigraphic study showed that 2/3 of the patients had reflux, occurrence of which was not affected by the length of postoperative period. Scanning electron microscopic examination showed that degeneration, exfoliation of esophageal mucosal epithelial cell, and derangement of micro-fold and inflammatory oedema of cytomembrane may be directly caused by reflux. CONCLUSIONS: GER exists in the majority of the patients after esophagogastrectomy and esophagogastrostomy for cardiac cancer. The occurrence of GER is not affected by the length of postoperative period. Some detecting methods fail to show the existence of GER, and 24-h pH monitoring is the most reliable method for detecting GER. Sleep in semireclining position is an effective method of preventing GER in postoperative patients.
OBJECTIVE: To investigate the possible anti-reflux function of esophagogastric anastomosis in the patients after receiving resection of cardiac cancer. METHODS: One hundred and ninety-two patients were studied by video-assisted gastroscopy, manometry, 24-h pH esophageal monitoring, radioscintigraphy and scanning electron microscopy. RESULTS: Abnormalities were found in 90.2% of patients through endoscopy. Resting pressure in esophageal body was higher than that in normal controls, and in the stomach, lower. Twenty-four hour pH monitoring demonstrated that gastroesophageal reflux (GER) did not occur when the patients slept in semi-reclining position, and occurred in all patients when slept in supine position. Scintigraphic study showed that 2/3 of the patients had reflux, occurrence of which was not affected by the length of postoperative period. Scanning electron microscopic examination showed that degeneration, exfoliation of esophageal mucosal epithelial cell, and derangement of micro-fold and inflammatory oedema of cytomembrane may be directly caused by reflux. CONCLUSIONS:GER exists in the majority of the patients after esophagogastrectomy and esophagogastrostomy for cardiac cancer. The occurrence of GER is not affected by the length of postoperative period. Some detecting methods fail to show the existence of GER, and 24-h pH monitoring is the most reliable method for detecting GER. Sleep in semireclining position is an effective method of preventing GER in postoperative patients.
Authors: Ahmad Aly; Glyn G Jamieson; David I Watson; Peter G Devitt; Roger Ackroyd; Chris J Stoddard Journal: J Gastrointest Surg Date: 2009-12-09 Impact factor: 3.452