Radioisotope evaluation of the esophageal remnant and the gastric conduit after gastric pull-up esophagectomy

Background. The act of swallowing after gastric pull-up esophagectomy has n ot been thoroughly investigated. The aim of this study was to evaluate degl utition in the esophageal remnant and in the gastric conduit in patients wh o have undergone this operation. Methods, The residual radionuclide activity was measured IS seconds after a swallow in the esophageal remnant and at intervals up to a maximum of 120 minutes after a swallow in the gastric conduit. The scintigraphic rate of t ransit of a bolus fit both areas was compared in patients who had anastomos is in the neck (n = 15) versus patients Who had anastomosis in the chest (n = 19). Comparisons were also made between patients with and without sympto ms of dysphagia. The scintigraphic measurements were also correlated with a nastomotic diameters, measured with use of a volumetric balloon insufflatio n method at 3, 6, and 12 months after operation. Results, Them were no significant differences in esophageal I residual radi onuclide activity at 15 seconds after. a swallow in the groups With anastom osis in the neck versus anastomosis in the chest, with 30% residual activit y up to 12 months after operation in both groups (P = .24). In the patients as a whole the 50 % gastric conduit emptying time of 44 to 61 minutes did not change during the first postoperative year (P = .12). There was no asso ciation between anastomotic diameter and residual activity in the remaining esophagus (P > .126), Moderate and severe dysphagia Was reported in only a few patients, and there was no correlation between dysphagic symptoms and retention in the residual esophagus or slower emptying in the gastric condu it. Conclusions. The amount of peristaltic activity in the remaining esophagus after esophagectomy with. gastric replacement is unaffected by the level of the anastomosis. The gastric conduit empties slowly in all patients, and t here is no correlation between the rate of emptying and either anastomotic diameter or symptoms of dysphagia.