Esophageal and jejunal motility in patients with total gastrectomy reconstructed with Roux-en-Y loop

Abstract

The standard technique for reconstruction of the intestinal transit after total gastrectomy for gastric cancer is the Roux-en-Y anastomosis between the esophagus and a jejunal loop, which prevents the reflux of alkaline intestinal juice. The purpose of this study was to analyze the esophageal body motility and the motility of the proximal jejunal loop in patients subjected to total gastrectomy. A prospective cohort of 17 total gastrectomy patients, operated on 5 years earlier, were studied using high-resolution esophageal manometry including the first 7 cm of the jejunal loop. Manometry results were similar for all patients, showing normal esophageal body motility, with the exception of the maximum intrabolus pressure that was elevated in all cases. The jejunal loop motility was disordered and ineffective. Esophageal body motility was normal 5 years after total gastrectomy. However, maximum mean intrabolus pressure was elevated in all patients. The most plausible reason for this finding would be the resistance exerted by the motility of the jejunal loop. Although this abnormality might not explain the mild symptoms presented by some patients, its pathological consequences are of little relevance.