Lower Esophageal Motor Function and Mucosal Hemodynamics in Patients after Nonshunting Operations for Esophageal Varices

Hitoshi Shiozaki, Shigeyuki Tamura, Kenji Kobayashi, Hirohi Yano, Hideaki Tahara, Mikiyo Miyata, Hiroshi Oka, Yuichiro Doki, Keisuke Iihara, Micho Ogawa, Yoshihiro Kido, Atsuo Murata, Toshimasa Tsujinaka, Junichi Nishijima, Takesada Mori

The Second Department of Surgery, Osaka University Medical School

Between 1975 and 1989, 50 proximal gastrectomies (PG) and 55 esophageal transections (TR) were performed in our hospital. More than 5 years after PG, 6 patients had incurable anastomotic ulcers with bleeding. To determine the causes, the lower esophageal motor function and esophageal mucosal blood flow in 6 PG patients and 16 TR patients were investigated. In patients without reflux esopagitis who underwent TR, the swallowing contraction wave (31.9 mmHg) was higher than in patients with reflex esophagitis (14.0 mmHg). The esopageal motor functions did not differe significantly between the PG and TR groups. The index of mucosal blood volume in TR patients (99.1) was significantly (p<0.05) higher than in PG patients (84.3), but the index of estimated oxygen saturation of the Hb was not different in these two groups. In conclusion, the results suggest that the reflux esophagitis after TR is due to the decrease in clearance in the lower esophagus, and that the decrease in the lower esophageal blood flow significantly contributes to formation of an incurable anastomotic ulcer after PG.

Key words
nonshunt operation methods for esophageal varices, postoperative esophageal mucosal blood flow, postoperative esophageal motor function

Reprint requests
Hitoshi Shiozaki The Second Department of Surgery, Osaka University Medical School
1-1-50 Fukushima, Fukushma-ku, Osaka, 553 JAPAN

Accepted
June 13, 1990

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