Functional evaluation of interposed colon in esophagus. Manometric and 24-hour pH observations

Colon interposition was performed on 22 patients for benign esophageal disease which had not responded to medical or other surgical treatment. Left colon was used as the interposed segment in 17 cases, transverse colon in two and right colon in three cases. All left colon grafts were positioned antiperistaltically. Manometric studies showed no basal or stimulated motor activity in any of the 22 grafts. The peristaltic activity in the esophageal remnant could be demonstrated in four patients. Thirteen patients were studied with 24-hour pH measurements. Distinct acid reflux to the lower colon graft was observed in only one case. Interposed colon thus was confirmed to function as a passive conduit without motor response to swallowing stimuli. The rarity of acid reflux after colon replacement of esophagus probably is due to the vagotomy usually performed during the operation and to the alkalinity of colon mucus.