J.Jpn. Surg. Soc.. 56(10): 1387-1402, 1956

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ROENTGENOLOGIC STUDIES ON THE ALIMENTARY TRACT AFTER ESOPHAGEAL SURGERY, ESPECIALLY ON ANTETHORACIC ESOPHAGO-GASTROSTOMY

Radical operation for the patients with esophageal cancer has been successfully performed in our clinic and the number of cases undergoing antethoracic esophago-gastrostomy counts for as many as 151 for a period ranged from 1948 to June 1955. Roentgenologic studies have been done on the alimentary tract of patients with antethoracic anastomosis, in combination with the postoperative complaints, and a comparison has been done with those of patients with right or left intrathoracic esophago-gastrostomy. Résumé of results obtained was as follows:
1) No marked difficulties in deglutation were noted except occasional stricture formation at the anastomotic portion. There were only a few complaints regarding the act of swallowing in those patients in whom the remnant gastric porch in the left thorax is small and spastic condition is easily apt to be induced at the pyloric region. In these cases, barium enema retained for a pretty long time in the esophagus.
2) Regardless of the operative method, the supine position of the patients induces reflux of barium enema from the stomach, which is enough to notice the causality of postoperative esophagitis-like symptom. Elevation of the upper body effects to eliminate or mitigate these untoward symptoms. These complaints, however, are not so pronounced except left intrathoracic anastomosis.
3) Those cases, in whom the gastric motion is so week that the peristaltic rhythm is scarcely measured, were found most infrequently in the group of antethoracic anastomosis among three groups.
4) A shadow of barium enema in the stomach, projected on the fluoroscopic plate, was sketched at regular intervals and its area was measured by means of the planimeter. The rate of reduction in this area may be presented in the form of a curve, which was denoted tentatively as the excretion curve of gastric contents by the author. This curve was classified into the foIIowing three typse: promoting, normal and delaying types. This study was done for a comparison among these three operative motheds. In the cases with antethoracic anastomosis there was found only the promoting or the normal type, whereas in those with intrathoracic union there was further the small number of delaying type besides other two types. The relationship between the excretion curve of gastric contents and the postoperative complaints was studied. In the small number of the promoting type of this curve, early postprandial symptoms were found regardless of the difference of operative method. It was also evidenced that "complaints due to elevation of the gastric pouch in the thorax" were found in the group of the normal or the delaying type, and these complaints occurred more intensively in those whose gastric pouch occupied a bigger space in the thoracic cavity.
(author's abstract)

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