RE, CLE common following cervical esophagogastrostomy irrespective of route
MedWire News: Reflux esophagitis (RE) and columnar-lined esophagus (CLE) are frequently observed in patients who undergo cervical esophagogastrostomy following esophagectomy irrespective of the route of esophageal reconstruction, Japanese researchers have found.
The study findings also showed that the incidence of RE and CLE significantly increased with the passage of time after surgery.
Toshiaki Tanaka (Kurume University School of Medicine) and colleagues reviewed the endoscopic findings of 100 patients who underwent cervical esophagogastrostomy after resection of the thoracic esophagus at 1 month, 1 year, and 2 years after surgery. The incidence rates of RE and CLE with the passage of time and among the three reconstruction routes (subcutaneous n=31, retrosternal n=26, and posterior mediastinal n=43) were then compared.
The researchers found no significant difference in the incidence rates of RE at 1 month (42%), 1 year (37%), and 2 years (38%) after surgery. However, the incidence rate of severe RE (Grade C and D in the Los Angeles classification system) significantly increased with the passage of time, at rates of 9%, 18%, and 22%, respectively.
A pattern similar to that for severe RE was seen for CLE, with incidence rates increasing from 0% at 1 month after surgery, to 14% at 1 year, and 40% at 2 years after surgery.
Tanaka et al also note that half the patients with severe RE after esophagogastrostomy were not relieved of severe RE despite acid suppression therapy, and that patients without severe RE after surgery frequently developed severe RE with the passage of time.
No correlation was found between Helicobacter pylori infection and the development of severe RE, despite positive H. pylori infection seen more frequently in the RE developed group than in the RE improved group.
Furthermore, no difference in the incidence of RE and severe RE was found among the three routes of esophageal reconstruction. Nor was any difference found in the acid exposure into the remaining esophagus 2 years after surgery according to the route of reconstruction.
“Careful endoscopic follow-up is necessary for patients who under[go] cervical esophagogastrostomy irrespective of the route of esophageal reconstruction,” conclude the authors in the Diseases of the Esophagus journal.
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By Ingrid Grasmo