Korean J Thorac Cardiovasc Surg.  2006 Dec;39(12):920-926.

Assessment of the Quality of Esophago-gastric Anastomosis by Endoscopic Examination Cervical Versus Intrathoracic Anastomosis

• Shim JH
• Choi YH
• Kim HK
• Baek MJ
• Kim HJ

Abstract

BACKGROUND: Mortality and morbidity of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux symptoms after esophagogastrostomy continue to be a burden jeopardizing the quality of life. In the present study, we evaluated the quality of esophagogastrostomy by analyzing anastomotic stenosis and reflux esophagitis. MATERIAL AND METHOD: A retrospective analysis was made in 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. 53 patients of them received endoscopic examination during follow-up (29+/-23.6 months, range 5~111 months). Reflux esophagitis and stenosis at anastomostic site were analyzed according to the techniques and locations of esophagogastrostomy. RESULT: The median age at the time of repair was 60.3+/-8.87 years (range 39~81 years). 23 patients received a hand-sewn esophagogastric anastomosis and 30 patients a circular stapled one. There was no significant statistical difference in terms of anastomotic stenosis (p=0.64) and reflux esophagitis (p=0.41) between the two groups. Cervical anastomosis was performed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in anastomotic stenosis between the two groups was found (p=0.44), but reflux esophagitis was noted in 3 patients in the cervical anastomosis group and 14 patients in the intrathoracic anastomosis group (p=0.003).
CONCLUSION
Cervical anastomosis was supposed to have a better quality of esophagogastrostomy by lowering the risk of reflux esophagitis. In the future, the comprehensive study including a patient's subjective symptom and Barrett's metaplasia should be performed in larger cases.

Keyword

Esophageal cancer; Anastomosis, surgical; Endoscopy; Quality of life

MeSH Terms

Anastomosis, Surgical
Constriction, Pathologic
Deglutition
Endoscopy
Esophageal Neoplasms
Esophagectomy
Esophagitis, Peptic
Follow-Up Studies
Humans
Metaplasia
Mortality
Quality of Life
Retrospective Studies