Pharyngeal reflux after gastric pull-up esophagectomy with neck and chest anastomoses

Objective: Pharyngeal reflux after a gastric pull-up esophagectomy,may caus e aspiration. This study evaluates acid exposure to the esophageal remnant and to the pharynx after gastric Dull-up esophagectomy and evaluates the im pact of additional dissection of the esophagus that is necessary for neck a nastomoses versus no neck exploration and proximal chest anastomoses. Metho ds: Forty-seven patients had circular stapled anastomoses in the apex of th e right chest (n = 27 patients) or manually sutured neck anastomoses (n = 2 0 patients). A 24-hour double-pH study with the probes placed 3 cm cranial and 3 cm distal to the cricopharyngeal muscle was performed. The percent ti me pH less than 4 was registered 3, 6, and 12 months after the operation. R esults: Mean acid exposure to the proximal pH probe ranged between 0.2% and 0.96% and between 1.45% and 6.5% to the distal pH probe during the 3 measu rements. Acid exposure was always lower to the proximal than to the distal probe (P =.001). Patients with neck anastomoses had increasing acid exposur e to the distal (P =.023) and proximal (P = .002) pH probes during the stud y year, whereas patients with chest anastomoses had similar acid exposure. Conclusions: acid exposure to the esophageal remnant and to the pharynx inc reased during the first postoperative year in patients,vith neck anastomose s but not in patients with proximal chest anastomoses. The results suggest a less favorable acid clearance in patients with the neck approach.