STUDY ON PREVENTION AGAINST POSTOPERATIVE REFLUX ESOPHAGITIS FROM THE LOWER ESOPHAGUS AND THE CARDIA CANCER

Abstract

For 50 cases of fundectomy (gastroesophagostomy) and 29 cases of total gastrectomy, complains of postoperative reflux esophagitis, X-ray examinations, fiberscopic observations, biopsies, and determinations of esophageal pH were investigated, and the following results have been obtained :
1. Esophagitis symptoms were classified as, “moderate”, “mild”, and “sever”.
2. Endoscopic criteria were classified as, “mucosal color tone change type”, “erosion-ulcer type”, and “hyperplastic swelling type”. Endoscopy grade was devided into I, II, and III, mainly under reference of infiltration extent.
3. Biopsy criteria was used to judge neutrophil infiltration, parakeratosis, basal zone's change, expansion and increase of blood vessel on lamina propria, and fibrosis.
4. Observing the similarity of the pH curve of esophageal mucous membrane to that on jujunal interposition, it was shown that gastroesophagostomy is little influenced by gastric juice and duodenal juice.
5. As prevention against regurgitation, a slim stomach tube was used, and for anastomosis, the pointed end of esophagus was made to invaginate inside the tube.
6. In gastroesophagostomy, there were few occurrences of esophagitis. The symptoms were of light grade, and in the course of time after operation, they became very well.
7. During endoscopy investigations and gastroesophagostomy, there was observed slight and limited esophagitis near the anastomatic site, but there was no tendency toward worsening in the progress of time.