Earlier prediction of anastomotic insufficiency after thoracic esophagectomy by intramucosal pH

Objectives: To assess the value of using intramucosal pH (pHi) measurements to evaluate the viability of the gastric tube after thoracic esophagectomy , acid to determine whether these measurements may be used for early predic tion of anastomotic insufficiency. Design: Prospective, observational study. Setting: University hospital in Japan. Patients: Thirty-nine patients who had undergone thoracic esophagectomy as a treatment for esophageal cancer. Interventions: The blood flow within the gastric tube was measured using a laser Doppler flowmeter during surgery. Periodic measurement of the pHi wit hin the gastric tube (gastric pHi) began during surgery and continued until the second postoperative day. In 30 patients, the pHi within the rectum (r ectal pHi) was measured simultaneously with the gastric pHi. The patients w ere divided into two groups: those patients who experienced anastomotic ins ufficiency constituted the leakage(+) group (n = 13); those patients who di d not experience these complications were designated the leakage(-) group ( n = 26). Measurements and Main Results: The gastric pHi values correlated significan tly with simultaneous measurements of the blood flow at the anastomotic sit e (p < .01). The postoperative gastric pHi values increased gradually in th e leakage(-) group but stopped increasing after surgery in the leakage(+) g roup. The rectal pHi values increased gradually after surgery in both group s. Furthermore, there was a significant difference between the two groups w hen their gastric pHi values were subtracted from their rectal pHi values f rom the morning of the first postoperative day until the morning of the sec ond postoperative day (p < .05). Conclusions: The gastric pHi values well reflected the viability of the gas tric tube, especially when combined with the rectal pHi values. By measurin g pHi, we can more accurately predict the risk of anastomotic insufficiency earlier after surgery and therefore give those patients who need it additi onal care to improve the viability of the gastric tube.