Duodenogastric Reflux after Esophagectomy and Gastric Interposition


Stomach is considered the “gold standard” as an esophageal substitute after esophagectomy. Re-flux disease is considered an unavoidable consequence of esophageal resection followed gastric interposition. Reflux esophagitis shows a progression from inflammation to erosions and to the development of columnar lined metaplasia. With the use of a gastric interposition, the most popular option to reconstruct the esophagus resected for malignant or benign conditions creates an in vivo model of reflux disease. Gastric interposition is far from ideal as an esophageal substitute. Reflux esophagitis and new columnar lined metaplasia should be seen as a new complication of subtotal esophagectomy.

Share and Cite:

Hashimoto, N. (2014) Duodenogastric Reflux after Esophagectomy and Gastric Interposition. Open Access Library Journal, 1, 1-7. doi: 10.4236/oalib.1100912.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Akiyama, H. (1990) Surgery for Cancer of the Esophagus: Reconstruction of the Esophagus. William and Wikins, Baltimore, 56-60.
[2] Gawad, K.A., Hosch, S.B. and Bumann, D. (1999) How Important Is the Route of Reconstruction after Esophagectomy: Prospective Randomized Study. American Journal of Gastroenterology, 94, 1490-1496.
[3] Van Lanschot, J.J.B., van Blankestein, M. and Oeis, H.Y. (1999) Randomized Comparison of Prevertebral and Retrosternal Gastric Tube Reconstruction after Resection of Esophageal Carcinoma. British Journal of Surgery, 86, 102-108.
[4] de Martinez Haro, L., Ortiz, A. and Parrill, P. (2001) Intestinal Metaplasia in Patients with Columnar Lined Esophagus Is Associated with High Levels of Duodenogastroesophageal reflux. Annals of Surgery, 233, 34-38.
[5] Byrne, J.P. and Attwood, S.E.A. (1999) Duodenogastric Reflux and Cancer. Hepato-Gastroenterology, 46, 74-85.
[6] Egberts, J.H., Schniewind, B. and Bestmann, B. (2008) Impact of the Site of Anastomosis after Oncologic Esophagectomy on Quality of Life—A Prospective, Longitudinal Outcome Study. Annals of Surgical Oncology, 15, 566-575.
[7] Blazeby, J.M., Metcalfe, C., Nicklin, J. and Barham, C.P. (2005) Association between Quality of Life Scores and Short-Term Outcome after Surgery for Cancer of the Esophagus Or Gastric Cardia. British Journal of Surgery, 92, 1502-1507.
[8] Dresner, S.M., Griffin, S.M. and Wayman, J. (2003) Human Model of Duodenogastro-Esophageal Reflux in the Development of Barrett’s Metaplasia. British Journal of Surgery, 90, 1120-1128.
[9] Chattopadhyay, T.K., Shad, S.K. and Kumar, A. (1993) Intragastric Bile Acid and Symptoms in Patients with an Intrathoracic Stomach after Esophagectomy. British Journal of Surgery, 80, 371-373.
[10] Malagelada, J.R., Ree, W.D.W. and Mazzotta, L.J. (1980) Gastric Motor Abnormalities in Diabetic and Postvagotomygastroparesia: Effect of Metoclopramide and Betanechol. Gastroenterology, 8, 286-293.
[11] Gutschow, C., Collard, J.M., Romagnoli, R., Salizzoni, M. and Hölscher, A. (2001) Denerved Stomach as an Esophageal Substitute Recovers Intraluminal Acidity with Time. Annals of Surgery, 233, 509-514.
[12] Hashimoto, M., Imamura, M., Shimada, Y., Shirakata, Y. and Takeuchi, K. (1995) Twenty-Four Hour Monitoring of pH in the Gastric Tube Replacing the Resected Esophagus. Journal of the American College of Surgeons, 180, 666-672.
[13] Yuasa, N., Sasaki, E., Ikeyama, T., Miyake, H. and Nimura, Y. (2005) Acid and Duodenogastroesophageal Reflux after Esophagectomy with Gastric Tube Reconstruction. American Journal of Gastroenterology, 100, 1021-1027.
[14] Vaezi, M.F. and Richter, J.E. (1996) Role of Acid and Duodenogastroesophageal Reflux in Gastroesophageal Reflux Disease. Gastroenterology, 111, 1192-1199.
[15] Rakovich, G., Brigand, C. and Gaboury, L. (2007) The Esophageal Remnant after Gastric Interposition (Abstract). French Society of Thoracic and Cardiovascular Surgery, Besancon. J Chir Thor Card Vasc, June, 258-259.
[16] Skinner, D.B. (1980) Esophageal Reconstruction. American Journal of Surgery, 139, 810-814.
[17] Shibuya, S., Fukudo, S., Shineha, R., Miyazaki, S., Miyata, G., Sugawara, K., et al. (2003) High Incidence of Reflux Esophagitis Observed by Routine Endoscopic Examination after Gastric Pull-Up Esophagectomy. World Journal of Surgery, 27, 580-583.
[18] Yamamoto, S., Makuuchi, H., Shimada, H., Chino, O., Nishi, T., Kise, Y., Kenmochi, T. and Hara, T. (2007) Clinical Analysis of Reflux Esophagitis Following Esophagectomy with Gastric Tube Reconstruction. Journal of Gastroenterology, 42, 342-345.
[19] Mathew, G., Myers, J.C., Watson, D.I., Devitt, P.G. and Jamieson, G.G. (1999) Motility across Esophageal Anastomosis after Esophagectomy or Gastrectomy. Diseases of the Esophagus, 12, 276-282.
[20] Mroz, C.T. and Kelly, K.A. (1977) The Role of Extrinsic Antral Nerves in the Regulation of Gastric Emptying. Surgery, Gynecology & Obstetrics, 145, 369-377.
[21] Keane, F.B., Dimagno, E.P. and Malagelada, J.R. (1981) Duodenogastric Reflux in Humans: Its Relationship to Fasting Antroduodenal Motility and Gastric, Pancreatic and Biliary Secretion. Gastroenterology, 81, 726-731.
[22] Lee, H.S., Kim, M.S., Lee, J.M., Kim, S.K., Kang, K.W. and Zo, J.I. (2005) Intrathoracic Gastric Emptying of Solid Food after Esophagectomy for Esophageal Cancer. Annals of Thoracic Surgery, 80, 443-447.
[23] Aly, A. and Jamieson, G.G. (2004) Reflux after Esophagectomy. British Journal of Surgery, 91, 137-141.
[24] Urschel, J.D., Blewett, C.J., Young, J.E., Miller, J.D. and Bennett, W.F. (2002) Pyloric Drainage or No Drainage in Gastric Reconstruction after Esophagectomy: A Meta-Analysis of Randomized Controlled Trials. Digestive Surgery, 19, 160-164.
[25] Yajima, K., Kosugi, S.I., Kanda, T., Matsuki, A. and Hatakeyama, K. (2009) Risk Factors of Reflux Esophagitis in the Cervical Remnant Following Esophagectomy with Gastric Tube Reconstruction. World Journal of Surgery, 33, 284-289.
[26] Borst, H.G., Dragojevic, D., Stegmann, T. and Hetzer, R. (1978) Anastomotic Leakage, Stenosis, and Reflux after Esophageal Replacement. World Journal of Surgery, 2, 861-864.
[27] Bemelman, W.A., Verburg, J., Brummelkamp, W.H. and Klopper, P.J. (1988) A Physical Model of the Intrathoracic Stomach. American Journal of Physiology, 254, G168-G175.
[28] Kim, H.K., Choi, Y.H., Shim, J.H., Cho, Y.H., Baek, M.J., Sohn, Y.S. and Kim, H.J. (2008) Endoscopic Evaluation of the Quality of the Anastomosis after Esophagectomy with Gastric Tube Reconstruction. World Journal of Surgery, 32, 2010-2014.
[29] Demeester, T.R., Johansson, K.E., Frantze, I., Eypasch, E., Lu, C.T., McGill, J.E. and Zaninotto, G. (1988) Indications, Surgical Technique, and Long-Term Functional Results of Colon Interposition or Bypass. Annals of Surgery, 208, 460-474.
[30] Metzger, J., Dogen, I., Beglinger, C., von Flüe, M. and Harder, F. (1999) Clinical Outcome and Quality of Life after Gastric and Distal Esophagus Replacement with an Ileocolon Interposition. Journal of Gastrointestinal Surgery, 3, 383-388.
[31] Mine, S., Udagawa, H., Tsutsumi, K., Kinoshita, Y., Ueno, M., Ehara, K. and Haruta, S. (2009) Colon Interposition after Esophagectomy with Extended Lymphadenectomy for Esophageal Cancer. Annals of Thoracic Surgery, 88, 1647-1653.
[32] Katsoulis, I.E., Robotis, I., Kouraklis, G. and Yannopoulos, P. (2005) Duodenogastric Reflux after Esophagectomy and Gastric Pull-Up: The Effect of the Route of Reconstruction. World Journal of Surgery, 29, 174-181.
[33] Wang, H., Tan, L.J., Feng, M.X., Zhang, Y. and Wang, Q. (2011) Comparison of the Short-Term Health-Related Quality of Life in Patients with Esophageal Cancer with Different Routes of Gastric Tube Reconstruction after Minimally Invasive Esophagectomy. Quality of Life Research, 20, 179-189.
[34] Park, C.H., Lee, J.I., Sung, J., Choi, S. and Ko, K.P. (2013) A Flow Visualization Model of Duodenogastric Reflux after Esophagectomy with Gastric Interposition. Journal of Cardiothoracic Surgery, 8, 192.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.