Jejunal interposition for benign esophageal disease. Technical considerations and long-term results

Thirty patients with benign intractable or complicated esophageal disease were treated with esophageal resection and isoperistaltic jejunal interposition. There were three anastomotic leaks (2 radiologic only) and one postoperative death (3.5%). Long-term follow-up results were favorable in all but one patient who had scleroderma. Despite this, radionuclide transit studies with a standardized solid egg white bolus showed a delayed transit (3.6 +/- 0.4 minutes) compared with normal controls (10.4 +/- 2.6 seconds) (p less than 0.001). The time activity curves and condensed image computer analysis of the 1-second frames showed that the contractions of the interposed jejunum were segmental rather than peristaltic. This accounts for the delayed transit in the esophageal group. Histologic studies on endoscopic biopsies of the jejunal loops obtained after 12 months of the operation confirmed the retention of a normal villous architecture with Paneth cell hyperplasia but no evidence of metaplasia.