Acid-related diseases following retrosternal stomach interposition

Background/Aims: Esophagectomy and reconstruction with retrosternal stomach interposition implies bilateral truncal vagotomy, which supposedly causes gastric functional impairment. Methodology: Esophagectomy and reconstruction with retrosternal stomach int erposition was performed on 15 men (mean age: 58.4 years) and 3 women (mean age: 43.6 years). The stomach was pedicled on the right gastric and right gastroepiploic artery without performing pyloroplasty. The cervical side-to -end anastomosis was sutured manually. The functional results were assessed 2-4 years postoperatively, by determin ing 24-hour qualitative intragastric pH-measurement, fluoroscopical gastric emptying studies, fasting gastrin levels, and endoscopy with biopsy studie s. Results: Endoscopy and biopsy confirm esophagitis in 12 patients, gastritis in 15 and a gastric ulcer in 1 case. Fluoroscopic examination documented a normal passage of contrast medium in 17, slight impairment in 1 case treat ed by balloon dilatation of the pylorus. Qualitative intragastric pH-measur ement revealed a total pH <3 in 22.5-98.05% of measuring events (mean: 74.3 1%) within 24 hours, in 18 cases. Only 4 patients had pH <3 in less than 50 %. Fasting gastrin levels (normal range: 25-110mU/L) varied from 48.78mU/L- 168.20 (mean: 85.23mU/L). Only 3 patients had levels > 110mU/L (maximum: 16 8.20mU/L). Conclusions: Acid-related diseases may also occur after truncal vagotomy an d retrosternal stomach interposition. Routine follow-up endoscopy and biops y studies should be done to prevent inflammatory complications and maintain the patient's quality of life.