Comparative post-operative study of prostheses, with and without an anti-reflux valve system, in the palliative treatment of esophageal carcinoma

BACKGROUND/AIMS: Palliative treatment of advanced esophageal carcinoma by e sophageal tunnelization with a prosthesis allows immediate relief of dyspha gia. However, the procedure is subject to a high rate of morbidity, includi ng gastroesophageal reflux (GER) present in all patients with a prosthesis positioned through the gastroesophageal junction, resulting in complication s (pyrosis, aspiration pneumonias, sleep disorders) and reduced quality of life in these patients who already have a lower rate of survival. In an att empt to reduce: GER and its complications, the authors created a surgical p rosthesis coupled to an anti-reflux valve system, comparing it to the use o f an esophageal prosthesis without an anti-reflux valve mechanism. METHODOLOGY: Twenty-two patients were allocated to 2 tunnelization groups: esophageal prosthesis without an anti-reflux valve mechanism (group 1) and surgical prosthesis coupled to an anti-reflux valve system (group 2). The G ER was quantified measuring esophageal-gastric pH, and using fluoroscopy, c ontrast radiographs and esophageal emptying scintigraphy. Initially, the pH of secretions in S1 (esophagus) and S2 (stomach) was determined using reag ent strips after aspirating their contents with different syringes. First w ith the patient seated at rest in bed, later performing a Valsalva maneuver , deep breathing and forced coughing. The same procedure was performed with the patient in left lateral decubitus, right lateral decubitus, and dorsal decubitus with the head of the bed lowered to 20 degrees. After finishing these maneuvers, 15ml of I molar acetic acid were infused through the cathe ter positioned in the antrum, and, after 5min, S1 and S2 material sampling was repeated in the same positions as mentioned above. RESULTS: The pH values between the various positions and maneuvers performe d in each group separately were not significantly different, but, if we com pare the 2 groups, and the secretions obtained in SI and S2, there was a si gnificant difference in pH measures in all positions. In the patients in gr oup I, SI presented a mean pH ranging from 2.87-3.62 in the initial measure s, and between 2.17 and 3.5 after the infusion of 15ml of 1 molar acetic ac id. On the other hand, in group 2, the mean pH of SI remained between 6.34 and 8.32 in the initial measures and between 4.99 and 7.33 in the presence of acid infusion. At the level of S2, the pH remained unchanged between 2 a nd 2.7, in both groups. CONCLUSIONS: The authors conclude that the association of an esophageal pro sthesis with a valve system significantly reduces GER, as compared with its use alone. Furthermore, it allows marked reduction of the symptoms and res ulting complications, and does not interfere clinically with esophageal emp tying. It thus significantly improves the quality of life of these patients .