Gastric Emptying in Esophageal Substitutes
For patients undergoing esophagectomy, the stomach is the organ that is most commonly used to restore continuity in the gastrointestinal tract. As a consequence of changes in stomach shape and location, patients in the postoperative period usually experience disturbed motility of the upper gastrointestinal tract of variable intensity.
The aim of the study was to assess the motility of esophageal substitutes and the emptying rate of a narrowed stomach (in particular its prepyloric portion) using scintigraphy in patients undergoing esophageal resection compared to those in healthy controls.
Material and methods. Between 2000 and 2006, 297 patients (105 women, 192 men) underwent surgical treatment for esophageal cancer in the Clinic of Gastrointestinal Surgery. Ten patients (average age 59; range 54 to 67 years) who underwent an attempted curative esophageal resection were selected into the study group. Patients from this group underwent scintigraphic assessment of gastric emptying between three to 11 months after the surgical procedure (an average 7 months). Furthermore, ten healthy volunteers (average age 28; range 19 to 43 years) constituted the control group.
Results. The average radiotracer retention after two hours was 44.7±6.5% in the study group and 51.1±7.4% (p>0.2) in the control group. Frequency of contractions of the whole prepyloric segment, as well as its distal fragment, in the subsequent periods of examination was comparable in both groups. Correlation among the frequency of contractions, contraction duration and duration of relaxation of the whole prepyloric segment and its distal fragment was high for the control group (correlation coefficients 0.71 p<0.001; 0.71 p=0; and 0.63 p=0, respectively). In the study group, correlation between the frequency of contractions and contraction duration was poor (coefficients of correlation 0.03 p>0.8 and -0.02 p>0.9), while correlation between duration of relaxation of the whole prepyloric segment and its distal fragment was moderate (coefficient of correlation 0.34 p>0.06).
Conclusions. Formation of a gastric substitute after its narrowing and denervation (truncal vagotomy) does not abolish gastric contractility. Frequency, amplitude, duration of contraction, and relaxation duration of the prepyloric portion of the ectopic substitute do not differ significantly from the patterns of motility of the upper gastrointestinal tract in healthy volunteers.