Function of a free jejunal "conduit" graft in the cervical esophagus

The function of an autotransplanted jejunal graft used to reconstruct the pharyngoesophagus was evaluated in 12 patients, 2-40 mo after surgery. On clinical assessment most patients swallowed liquids and solids with minimal difficulty, although several described a need for liquids to "flush" solids to the stomach. Radiologic studies demonstrated a delay in orogastric transit in some patients above the lower anastomosis. The mechanism was apparent on motility studies: swallows generally failed to induce contractions in the graft, although the esophagus below exhibited stripping peristaltic waves. Regular contractile activity, characteristic of phase III of the intestinal migrating motor complex, was identified in 11 grafts. There was no temporal association between migrating motor complexes in the graft and those recorded at the jejunal donor site. Instillation of nutrients into the gastric antrum induced a typical "fed" pattern of contractions in the intact jejunum but not in the extrinsically denervated graft. In conclusion, the graft provides a useful, though generally passive conduit. The graft maintains its intrinsic motor repertoire, which is asynchronous with that of the donor site. The findings also support the hypothesis that extrinsic nerves are required to induce a "fed" pattern of intestinal motility.