Functional evaluation of distal esophagus and lower esophageal sphincter after esophagogastric devascularization, esophageal transection and antireflux procedure for bleeding esophageal varices.

Distal esophageal function and LES competence were evaluated in 21 patients by means of esophageal manometry and standard pHmetry after Sujura mod. operation for bleeding esophageal varices. This operation involves complete devascularization of 10-12 cm. of distal esophagus, disruption of anatomic anti-reflux mechanism, excision of nearly one cm. of muscular tissue at lower esophageal sphincter level. Intraoperative manometry was performed in 8 patients and demonstrated a significant shortening of high pressure zone, while lower esophageal sphincter pressure did not show significant variations. Postoperatively gastroesophageal reflux at pHmetry was not observed (five patients had pathological reflux preoperatively). No significant variations of resting lower esophageal sphincter pressure and no peristaltic alterations were observed. In conclusion despite the marked anatomic alterations related to this procedure, sphincter dynamics and distal esophageal function remain nearly normal.