[Treatment of sclerodermic esophagitis: value of duodenal diversion]

Between 1985 and 1990, six patients were operated on using duodenal diversion for reflux esophagitis with scleroderma. Duodenal diversion was performed twice as initial procedure and 4 times as treatment of unsuccessful antireflux procedure performed ten years previously. Duodenal diversion was associated with truncal vagotomy. In cases of reoperation the initial reconstruction procedure was removed. An esophageal stricture was resected in one case. One patient with previous truncal vagotomy and pyloroplasty underwent supra papillary diversion. There was no postoperative death. The mean follow-up was 28 months with one patient lost to follow-up. For 4 patients, the postoperative weight gain was 10 per cent. Abnormalities of lower esophageal motility in scleroderma account for the poor results after classical antireflux procedures. In these cases duodenal diversion is indicated as primary treatment. In cases of reoperation removal of the initial anti-reflux device is required in association with duodenal diversion.