August 1994

Functioning of the Intrathoracic Stomach After Esophagectomy

Author Affiliations

From the Department of Surgery II, Yamaguchi University School of Medicine, Kogushi, Japan. Dr Nishikawa is currently with the Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock.

Arch Surg. 1994;129(8):837-841. doi:10.1001/archsurg.1994.01420320063012

Objective:  To investigate acid secretion and motility of the intrathoracic stomach with truncal vagotomy after esophagectomy.

Design:  Case-control study of patients undergoing esophagectomy, with average follow-up of 3.2 months, compared with healthy controls.

Setting:  Yamaguchi University School of Medicine, Kogushi, Japan.

Patients:  A random sample of 21 patients selected from 79 patients with esophageal cancer during the period from May 1988 to August 1993 received the intrathoracic stomach after subtotal esophagectomy. A control sample consisted of 14 men.

Interventions and Main Outcome Measures:  For acid secretion, a pH probe was placed in the intrathoracic stomach to measure the average pH value (average of total monitoring values) and pH holding time (ratio of the period during which the pH value was 3 or higher based on the entire continuous monitoring periods). For motility, digestive tract scintigraphy was performed to obtain the time activity curve from the analog image observed when patients ate meals labeled with indium 111. In addition, hemorrhagic ulcers in the intrathoracic stomachs of three patients were reported.

Results:  A pH value below 3 was recognized after surgery, and there was no significant difference between pH values in patients and normal volunteers (average pH value, 3.9±1.5 vs 3.3±1.9; pH holding time, 52.2±20.2% vs 57.1 ±24.4%, respectively). The time activity curve of the intrathoracic stomach observed by scintigraphy underwent no change after surgery. Among three patients with hemorrhagic ulcers, two exhibited improvements after receiving a histamine blocker, while in the other, it was not effective.

Conclusion:  Acid secretion ability and motility of the intrathoracic stomach with truncal vagotomy may be unchanged after esophagectomy.(Arch Surg. 1994;129:837-841)