Functional results of gastric interposition following total esophagectomy

Functional results of gastric interposition were evaluated in 35 patients at 3 to 84 months following esophagectomy. All patients were satisfied with the results of surgery, although 14 (40%) still experienced some degree of dysphagia. Transit times for radiolabeled solids across the cervical esophagus and anastomosis were not significantly different for the 14 symptomatic patients (mean 77 seconds) versus 21 asymptomatic patients (mean 55 seconds). Spontaneous emptying of the vagotomized intrathoracic stomach appeared complex, with mean percentage radionuclide clearances at 30 minutes (semisolid meal) calculated at 37% for 23 patients with early satiety (versus 42% asymptomatic) and at 38% for nine patients with reflux (versus 39% asymptomatic), all values comparable to emptying of the normal intra-abdominal stomach (35% clearance at 30 minutes). Our data suggest that the interposed stomach appears to retain its gastric identity rather than act as an inert conduit, and that although little correlation exists between postoperative symptoms and objective findings, the stomach remains a satisfactory esophageal substitute.