Peptic Ulcer in the Gastric Tube after Surgery for Esophageal Cancer

Tetsuhiko Okamoto, Yoh Isobe, Masaki Arimori

Department of Surgery, Second Tokyo National Hospital

A peptic ulcer was found in the gastric tube 2 years and 8 months after surgery for esophageal cancer. A 54-year-old man who underwent esophagectomy for intrathoracic esophageal cancer and gastric tube replacement through the retrosternal route in July 1988, complained of tarry stool and anemia in March 1991. On admission, endoscopic examination revealed a peptic ulcer in the anterior wall of the gastric tube. Biopsy specimens were not malignant. He was treated medically with an H₂-blocker and proton pump inhibitor during 4 weeks. The next endoscopic study did not show the ulcer in the gastric tube. This patient was still alive in January 1992 with no recurrence of ulcer or cancer. On admission, the plasma gastrin level was high and both BAO and MAO were low on the gastrin stimulating test. Continuous 24-hour pH monitoring in the gastric tube did not show a low pH value at fasting. Although there are many causes of ulcer formation, we consider that ischemic change in the gastric tube mucosa might play a part in the pathogenesis of peptic ulcer.

Key words
peptic ulcer, gastric tube for esophageal replacement, postoperative complication in the esophageal cancer

Reprint requests
Tetsuhiko Okamoto Department of Surgery, Second Tokyo National Hospital
2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152 JAPAN

Accepted
September 9, 1992

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