Stomach pull-up versus colon bypass as an esophageal substitute in treating post-corrosive stricture

Sixteen patients with corrosive esophageal stricture were included in this study. There were 9 females and 7 males. Their ages ranged from 10 to 22 years. Indications for surgery were too long strictures, too tight strictures, and multiple strictures with failure of endoscopic dilatation. In 9 patients [group I], colon was used as esophageal substitute [colon bypass in 7 patients and colon replacement in 2 patients]. For the other 7 patients [group II]. stomach pull-up was the technique adopted. Patients follow-up was achieved by upper gastrointestinal [GI] endoscopy, barium studies, 24 hours pH monitoring and manometric studies. Stomach pull-up surgery utilized shorter time and less blood units. There were no mortalities among both groups. The following complications were recorded: anastomotic leaks [3 in group I - 2 in group II], reflux symptoms [2 in group I - 2 in group II], and cervical anastomotic strictures [2 in group I - 1 in group II]. One patient in group II complained of dumping symptoms while one patient in group I suffered from recurrent food regurgitation. Most symptoms were treated medically except one patient on group I with persistent stricture which necessitated revision of neck anastomosis. Barium and manometric studies [done for 5 patients only] proved that thoracic-transposed stomach by time changed into a conduit rather than a reservoir with active peristalsis while colon transmitted foods and drinks by gravity with no evidence of any peristaltic waves. Two patients in group II had iron-deficiency anemia. Stomach proved to be a challenging esophageal substitute to colon graft in treating benign esophageal strictures. More long-term follow-up studies are required to assess the metabolic results

Esophageal motility and pH metry in cirrhotic patients

The aim of the study was to evaluate esophageal motility and gastroesophageal reflux disease [GERD] in patients with bleeding and non-bleeding esophageal varices [EV] using the state of the art equipment and the prolonged ambulatory pH metry. Seventy patients with liver cirrhosis were selected and classified into three groups; 20 patients without esophageal varices [control group], 20 patients with different grades of esophageal varices with no history of variceal bleeding [group I] and 30 patients with different grades of esophageal varices with history of variceal bleeding and previous endoscopic injection sclerotherapy [group II]. According to the grades of EV, groups I and II were further subdivided into subgroup A [grade I and II EV] and subgroup B [grade III and IV EV]. All the patients were exposed to full clinical and laboratory assessment, abdominal sonography, upper GI endoscopy beside esophageal motility study and prolonged ambulatory pH monitoring. The results were presented and discussed