Intraesophageal Pressure in Patients Receiving Proximal Gastrectomy with Hinged Double Flap Method for Gastric Cancer

Abstract

AbstractBackground Objective functional assessment of esophagogastric anastomosis in patients who underwent proximal gastrectomy with the hinged double flap method for gastric cancer has not been well investigated. This study aimed to perform a functional analysis of reconstruction using high-resolution impedance manometry (HRIM). Methods The subjects comprised 25 patients receiving proximal gastrectomy for gastric cancer between May 2015 and April 2020. Eligible questionnaires (Postgastrectomy Syndrome Assessment Scale − 37 [PGSAS-37]) were retrieved from 16 patients. The data of this study were compared with the values of the Japanese standard data from the PGSAS study. Results The quality of ingestion subscale had a significant influence on patients’ weight loss and weight loss rate one year after surgery (r = -0.874, p = 0.0048, r = -0.876, p = 0.0044, respectively). The amplitudes of distal esophageal peristaltic waves, contractile front velocity, and distal latency assessed by HRIM were almost normal after surgery. Most patients showed lower esophageal sphincter (LES) resting pressure within normal limits, whereas all patients showed abnormal LES residual pressure during swallowing-induced relaxation. However, high LES residual pressure during swallowing-induced relaxation did not attribute to deterioration the patients’ quality of life; the results of the PGSAS-37 score in this study were comparable to the values of patients who underwent proximal gastrectomy in Japan. Conclusions Proximal gastrectomy impaired swallowing-induced relaxation of LES. On the other hand, LES resting pressure created by the hinged double flap was maintained after surgery, and the postoperative outcome was good.