THE DENERVATED STOMACH AS AN ESOPHAGEAL SUBSTITUTE IS A CONTRACTILE ORGAN

Objective To determine whether the denervated stomach as an esophageal substitute is an inert conduit or a contractile organ. Summary Backgr ound Data The motor response of gastric transplants to deglutition sug gests that the stomach pulled up to the neck acts as an inert organ. M ethods The gastric motility of ii healthy volunteers and 33 patients h aving either a gastric tube (G.T) (n = 10) or their whole stomach (WS) (n = 23) as esophageal replacement was studied with perfused catheter s during the fasting state, after a meal, and after intravenous admini stration of erythromycin lactobionate. A motility index:: was establis hed for each period of recording by dividing the sum of the areas unde r the curves of all contractions of >9 mmHg by the time of recording. Results Over years, the denervated stomach recovers more and more moto r activity, even displaying a real phase 3 motor pattern in 6 of the 1 0 WS patients and 1 of the 7 GT patients with >3 years of follow-up. E rythromycin lactobionate generates a phase 3-like motor pattern regard less of the length of follow-up. Extrinsic denervation of the whole st omach does not significantly modify the fasting motility index establi shed >3 years after surgery (+17% on average, p > 0.05), but it reduce s that in the led period by an average of 62% (p = 0.0016). Tubulizati on of the denervated whole stomach lowers the fasting motility index b y an average of 60% (p = 0.0248) and further impairs that in the fed p eriod by an average of 67% (p = 0.0388). Conclusions The denervated st omach as an esophageal substitute is a contractile organ that may even generate complete migrating motor complexes. Motor recovery is better in the fasting than in the fed period, and it is more marked in WS pa tients than in G.T patients.