Gastric emptying after oesophagectomy as assessed by plasma paracetamol concentrations

Gastric emptying after oesophagogastrectomy may be affected by opposing influences. Truncal vagotomy of the orthotopic stomach, as used by surgeons for peptic ulcer, results in delayed gastric emptying. The emptying of such a denervated stomach is affected by position and posture and may result in gastric "incontinence", particularly if associated with drainage procedures. It is possible that postural effects may outweigh the reduced motility if the vagotomised stomach is transplanted into the chest as after oesophagogastrectomy. Despite the effect that disturbed gastric emptying may have on nutrition and drug absorption there have been few studies concerning patients who have had oesophageal resection or bypass. We report our preliminary experience of an indirect method to estimate gastric emptying after oesophageal resection and bypass, using the absorption profile of paracetamol (acetaminophen). This technique is safe and has been shown to reflect gastric emptying accurately in the innervated stomach. With this technique we have shown that, even in the absence of a concomitant drainage procedure, oesophageal resection, or bypass, using the denervated stomach to restore alimentary continuity does not result in any detectable delay in gastric emptying.