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ID: 206 (Conflict of Interest: K)

Azidität des Mageninterponates bei Patienten nach minimal invasiver Ivor Lewis Ösophagektomie kann bereits innerhalb kurzer Zeit zur Bildung von Neo-Barrett beitragen

H.Fuchs, D.Müller, F.Berlth, C.Fuchs, P. S.Plum, M.Maus, W.Schröder, C. J.Bruns, J. M.Leers
Universitätsklinikum Köln, Köln

Einleitung

As shown in literature, up to 50% of patients develop Neo-Barrett’s Esophagus above the anastomosis after Ivor-Lewis esophagectomy. Due to bilateral vagotomy during this operation, gastric acidity was thought to be reduced permanently. Aim of this study is to answer the question how and when acidity of the gastric conduit recovers over time and to analyze how this phenomenon contributes to the significant mucosal damage of the esophageal remnant.

Material und Methoden

Prospective study to evaluate the gastrointestinal functional outcome in patients after Ivor Lewis esophagectomy. In our esophageal center of Excellence, more than 250 esophageal surgeries are performed annually and a large proportion of tumor patients are seen during follow up on a regular scheduled base. IRB approval and a local grant have been received to support this project. A total of 75 patients with R0 resection and reflux symptoms after esophagectomy are scheduled to undergo endoscopy and functional tests in our laboratory. Functional tests include 24 h impedance pH metry and oropharyngeal (Restech) pH metry. Group comparisons are performed in accordance to length of follow-up to analyze the acidity of the gastric conduit during long term follow up.

Ergebnisse

A total of 35 (7 females) patients with a median age of 62 (range 39-80) were recruited so far and followed up after minimally invasive Ivor Lewis esophagectomy (median follow up 29 months). Adenocarcinoma was present in 23 patients, squamous cell carcinoma in 12. In routine surveillance endoscopy, all patients showed mucosal damage of the esophageal remnant. Symptoms reported were reflux (65%), regurgitation (71%) and bloating (85%). Already shortly after surgery (group 1, follow up 6-24 months) acidity of the gastric conduit is nearly normalized (mean pH 3,1; range 1,7-6,7). Mean pH in group 2 (Follow Up 24-48) and group 3 (Follow Up >48 months) is 3,3 (range 1,2-6,7), and 2,2 (range 1,6-2,9), respectively.  

Schlussfolgerung

Acidity of the gastric conduit in patients after Minimally Invasive Esophagectomy quickly recovers even though bilateral vagotomy is performed. This phenomenon seems to heavily contribute to the occurrence of mucosal damage in the esophageal remnant and has important implications on the pathogenesis of Barrett’s esophagus and esophageal cancer.