Functional evaluation of the interposed colon as an esophageal substitute.

Five Rhesus monkeys and four human adults with colonic reconstruction of the esophagus have been studied by manometric, fluoroscopic and reflux tests. Transit through the graft is mainly under the influence of gravity. Infrequent colon contractions can be propulsive, and sequential haustral contractions give the appearance of peristalsis. The diaphragmatic hiatus and esophagocolic anastomosis are the sites of weak barriers to reflux which are readily overcome by abdominal compression and gastric distension. Esophageal peristalsis is necessary to return refluxed material and cricopharyngeus muscle is the final barrier to regurgitation.