| Objective: Gastroesophageal reflux usually occures after gastroesophagectomy for cancer because of the resection of the low esophageal sphincters and destruction of esophagogastric diaphragm. It is reported that the location of esophagogastric anastomosis influences the extent of esophageal reflux. However, there are different results regarding the affects of the location of esophagogastric anastomosis on esophageal reflux. It is not demonstrated that the motility of the remnant esophagus and intrathoracic stomach were affected by the locations of esophagogastrostomy. Gastroesophageal reflux estimated by reflux symptom and esophagitis in the past was lack of objective evaluation. Therefore, in this study, endoscopy, manometry, 24 hour pH monitoring and upper alimentary tract roentgenography together with the questionnaire of gastroesophageal symptom were used to objectively estimate the motility of the remnant esophagus and intrathoracic stomach, the extent of gastroesophageal reflux and their affecting factors.Materials and Methods: Thirty-nine patients who ever underwent esophagectomy at the Department of Thoracic surgery, Fourth Hospital, Hebei Medical University between July 2002 and July 2003 were selected randomly, of whom 21 patients had esophageal carcinoma in the middle third, 2 patients had esophageal carcinoma in the lower third, 15 patients had cardial carcinoma. There were 32 male and 7 female with the mean age of 52 years. According to postoperative time (3 month and 12 month after surgery) and surgical procedure, 11 patients had anastomosis above aortic arch and 9 patients had anastomosis below aortic arch 3 month after surgery, 10 patients had anastomosis above aortic arch and 9 patients had anastomosis below aortic arch 1 year after surgery. Six healthy volunteers without gastroesophageal symptom served as control group. The symptom was graded and scored by questionnaire of all patients according to the method of DeMeester. Reflux esophagitis was endoscopically diagnosed and was graded and scored by Little classification. Esophageal intraluminal manometry was performed to observed resting pressure and peristaltic contraction of the remnant esophagus, intrathoracic stomach and anastomotic orifice. Twenty-four hour pH monitoring in esophagus was performed to record number of reflux episodes, number of reflux episodes longer than 5.0 minutes, longest reflux episodes, total time of pH below 4.00, fraction time of pH below 4.00 and DeMeester score. The peristaltic contraction of the intrathoracic stomach was observed by upper alimentary tract roentgenography. Statistical analysis: Student′s t test was used to compare with the scores of symptom of gastroesophageal reflux, esophagitis and the parameter of esophageal manometry. Wilcoxon nonparametric statistical test was used to compare the number of reflux episodes, DeMeester score and Score of fraction time of pH below 4.00. All statistical analyses were performed with the use of SAS 6.12 software. Differences were considered to be statistically significant when the P value was equal to or less than 0.05.Results: 1 The symptomatic score of heartburn in group of anastomosis below aortic arch was significantly higher than that of anastomosis above aortic arch 1 year after surgery (P=0.0064) and was also significantly higher than that of anastomosis below aortic arch 3 month after surgery(P=0.0265). There was no significantly difference between anastomosis above and below aortic arch 3 month after surgery (P=0.1598). In the group of anastomosis above aortic arch, significant differences in heartburn score were not seen between 3 month and 1 year after surgery (P=0.3166). 2 The extent of esophagitis in group of anastomosis below aortic arch was significantly higher than that of anastomosis above aortic arch 1 year after surgery (P=0.0483). However, there was no significant difference in the extent of esophagitis between anastomosis above and below aortic arch 3 month after surgery (P=0.4010). Postoperative time did not affect the extent...
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