Abstract: Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with midesophageal carcinoma. Methods Forty patients with midesophageal carcinoma were randomly divided into two groups. Esophageal bed group (n=20): the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group (n=20): gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying checkup were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients’s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h,  gt;5 min reflux frequency, the longest time of keep reflux, pH lt;4.00 total time and pH lt;4.00 of total time percent, these targets in both operation groups were higher than those in control group (P lt;0.01) DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pH lt;4.00 of total time and pH lt;4.00 of total time percent in esophageal bed group were lower than those in endothoracic group(P lt;0.01). The recent period of gastric emptying percentage (GE) in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering 
the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site,gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.

Citation： JIANG Zhiliang,YANG Jiwu,WANG Lin,LI Jianxin. Clinical Study of Gastroesophageal Reflux and Gastric Emptying after Esophagectomy with Gastric Replacement Through Esophageal Bed. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2007, 14(4): 271-274. doi: Copy