J Neurogastroenterol Motil 2016; 22(1): 157-158  https://doi.org/10.5056/jnm15121
Gastric Tube Motility Patterns in Patients After Esophageal Resection with Gastric Pull-up
Priscila R Armijo1, Fernando A M Herbella1,*, and Marco G Patti2
1Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil, 2Department of Surgery, University of Chicago, Il, Chicago, USA
Correspondence to: Fernando A M Herbella, MD, Department of Surgery, Escola Paulista de Medicina, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, Brazil 04037-003, Tel: +55-11-99922824, E-mail: herbella.dcir@epm.br
Received: July 23, 2015; Revised: August 18, 2015; Accepted: August 18, 2015; Published online: January 30, 2016.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Oral intake after esophagectomy is decreased in about a quarter of the patients, even in the absence of anastomotic or pyloric stenosis and in early-stage disease.1 Dysmotility of the vagotomized gastric tube may be a putative factor for dysphagia. The manometric motor activity of the gastric tube has been scarcely studied in the era of conventional manometry. Some studies showed that the fasting migrating motor complexes may occur late in follow-up in no more than half of the patients,2,3 but the gastric tube was virtually inert after swallowing.4,5

High-resolution manometry gives a detailed view that allows proper study of organs not conventionally studied by standard manometry in identifying the pressure impression of non-contractile anatomy structures, subtle peristalsis and flow obstructions. This technology is probably the most adequate to study the gastric tube after esophagectomy even though no previous studies focused on the topic.

Our figure illustrates high-resolution manometry findings in patients eating an unrestricted diet, and without anastomotic stenosis detected at upper endoscopy, that underwent trans-hiatal esophagectomy, gastric pull-up, and pyloroplasty for esophageal cancer. Absence of peristalsis was noticed in all patients, including the cervical esophageal stump. Pressurization of the esophagus proximal to the anastomosis and flow resistance at the level of the anastomosis as well as the thoracic inlet were secondary findings.

Figures
Fig. 1. High-resolution manometric findings of patients who underwent trans-hiatal esophagectomy for esophageal cancer showing: (A) aperistalsis, seen in 100% of the patients, (B) pressurization of the esophagus proximal to the anastomosis (arrow), (C) flow resistance at the thoracic inlet (arrow), and (D) flow resistance at the level of the anastomosis (arrow).

References
  1. Williams, VA, Watson, TJ, and Herbella, FA (2007). Esophagectomy for high grade dysplasia is safe, curative, and results in good alimentary outcome. J Gastrointest Surg. 11, 1589-1597.
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  2. Collard, JM, Romagnoli, R, Otte, JB, and Kestens, PJ (1998). The denervated stomach as an esophageal substitute is a contractile organ. Ann Surg. 227, 33-39.
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  3. Nakabayashi, T, Mochiki, E, and Garcia, M (2002). Gastropyloric motor activity and the effects of erythromycin given orally after esophagectomy. Am J Surg. 183, 317-323.
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  4. Bonavina, L, Anselmino, M, Ruol, A, Bardini, R, Borsato, N, and Peracchia, A (1992). Functional evaluation of the intrathoracic stomach as an oesophageal substitute. Br J Surg. 79, 529-532.
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  5. Nano, M, Battaglia, E, and Gasparri, G (2003). Decreased expression of stem cell factor in esophageal and gastric mucosa after esophagogastric anastomosis for cancer: potential relevance to motility. Ann Surg Oncol. 10, 801-809.
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