Antropyloroduodenal motility after resection of esophageal cancer.

OBJECTIVE

To study the mechanism of delayed emptying indigestible solids in thoracic stomach after the resection of esophageal cancer by monitoring the variety of antropyloroduodenal migrating motor complex (MMC) during interdigestion.

METHODS

Esophagectomy and gastroesophagostomy in the neck was performed in 5 men with esophageal cancer. An eight-lumen manometric sleeve assembly was passed through a nostril into the duodenum during operation. The sleeve was astride the pylorus. Antropyloroduodenal manometry was performed for at least 300 min with a polygraphic system (PC POLYGRAF HR) 7 - 11 days after operation.

RESULTS

Twenty-eight MMCs were recorded in the pylorus and duodenum, 12 MMC(s) in the antrum, and 33% (4/12) of the motility frequency of antral phases III started after that of pyloroduodenal phases III. The number of MMC in the antrum was lower than that in the duodenum after the operation. The mean duration of MMC of the antrum, pylorus and duodenum was (49.2 +/- 10.5) min, (46.5 +/- 10.4) min and (45.9 +/- 10.0) min respectively. The mean duration of phases III was respectively (6.7 +/- 3.5) min in the antrum, (10.0 +/- 3.5) min in pylorus, and (8.0 +/- 3.9) min in duodenum. The mean wave amplitude of phases III was respectively (83 +/- 30) mm Hg in the antrum, (60 +/- 12) mm Hg in pylorus, and (55 +/- 4) mm Hg in duodenum. The mean duration of MMC of the antrum and duodenum was shorter in patients than that in healthy volunteers, and the mean wave amplitude of phases III of the antrum was lower in patients than that in healthy volunteers.

CONCLUSIONS

Diminution of the number of MMC and the mean wave amplitude of phases III in the antrum, incoordination of the antropyloroduodenal phases III should be the most important one of the mechanisms of delayed emptying of indigestible solids in thoracic stomach after the resection of esophageal cancer.