POSTOPERATIVE GASTRIC-MOTILITY, SECRETORY FUNCTION, AND PREOPERATIVE AND POSTOPERATIVE CARBOHYDRATE METABOLIC STATES IN ESOPHAGEAL CANCER-PATIENTS

This study was undertaken to assess postoperative gastric motility and gastric acid secretion, and pre- and postoperative carbohydrate metab olism in patients with esophageal cancer. The gastric motility was com pared among 3 different reconstruction routes in 26 patients who were divided into 2 groups according to the duration of postoperative follo w-up; group A, 3 months or less; and group B, 18 months or more. The r outes used for subtotal resection of the stomach were the posterior me diastinal, retrosternal, and subcutaneous routes. All patients showed positive resting pressure in the esophagus, but peristaltic waves did not reach the gastric tube at dry swallowing in any patients and peris taltic waves appeared after eating pudding only in 1 patient in group B. The resting pressure and gastric emptying time were similar among r econstruction routes, but the incidence and amplitude of metoclopramid e (MCP)-induced peristaltic waves were significantly higher in group B than in group A. Furthermore, 24-h intragastric pH monitoring of gast ic secretion in a group of 9 patients revealed individual variation in gastric secretion. Some patients showed high acidity soon after opera tion, suggesting the need for prophylactic treatment for preventing ga stric ulcer. Postoperatively, postprandial serum gastrin levels were s ignificantly higher than preoperative levels. In the other group of 11 patients tested, preoperative and postoperative carbohydrate metaboli sm were not significantly different. Postoperatively, carbohydrate met abolism recovered to preoperative levels after a transient decrease. T hese results demonstrated that postoperative motility improved over ti me although no difference was found among the 3 reconstruction routes used.