Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan.
Dis Esophagus. 2010 Feb;23(2):94-9. doi: 10.1111/j.1442-2050.2009.00998.x. Epub 2009 Jul 31.
Reflux esophagitis (RE) and columnar-lined esophagus (CLE) are frequently observed after esophagectomy. The incidence of these conditions according to time and to the route of esophageal reconstruction after esophagectomy remains unknown. The aim of this study was to clarify any changes and differences of the incidence of RE and CLE in patients who underwent gastric tube reconstruction after esophagectomy. A hundred patients who underwent cervical esophagogastrostomy after resection of the thoracic esophagus were included in this study. We reviewed their endoscopic findings at 1 month, at 1 year and at 2 years after surgery, and compared the incidence rates of RE and CLE with the passage of time and among the three reconstruction routes; a subcutaneous route, a retrosternal route, and a posterior mediastinal route. The incidence rate of RE was 42%, 37% and 38%, at 1 month, 1 year and at 2 years after surgery, respectively. There was no significant difference in the incidence of RE according to the time after surgery. The incidence rate of severe RE (Grade C and D in the Los Angeles Classification) was 9% percent at 1 month after surgery, 18% at 1 year after surgery and 22% at 2 years after surgery, significantly increasing with passage of time. The incidence rate of CLE was 0% at 1 month after surgery, 14% at 1 year after surgery and 40% at 2 years after surgery, significantly increasing with passage of time. No difference was observed in the incidence of RE and that of CLE among the three routes of esophageal reconstruction. Severe RE and CLE increase with passage of time after cervical esophagogastrostomy. Therefore, careful endoscopic follow-up is necessary for such patients irrespective of the route of esophageal reconstruction.
食管胃吻合术后常发生反流性食管炎（RE）和柱状上皮化生（CLE）。吻合术后时间和食管重建途径对这些情况的发生率的影响仍不清楚。本研究旨在阐明胃管重建后食管切除术后患者 RE 和 CLE 发生率的变化和差异。本研究纳入了 100 例接受颈段食管胃吻合术的患者。我们回顾了他们术后 1 个月、1 年和 2 年的内镜检查结果，并比较了 RE 和 CLE 的发生率随时间的变化和三种重建途径（皮下途径、胸骨后途径和后纵隔途径）之间的差异。RE 的发生率分别为术后 1 个月、1 年和 2 年的 42%、37%和 38%，术后时间对 RE 的发生率无显著影响。重度 RE（洛杉矶分类 C 和 D 级）的发生率为术后 1 个月时为 9%，术后 1 年时为 18%，术后 2 年时为 22%，随时间推移显著增加。CLE 的发生率分别为术后 1 个月时为 0%，术后 1 年时为 14%，术后 2 年时为 40%，随时间推移显著增加。三种食管重建途径之间 RE 和 CLE 的发生率无差异。颈段食管胃吻合术后，重度 RE 和 CLE 随时间推移而增加。因此，无论食管重建途径如何，此类患者都需要进行仔细的内镜随访。
