Manometric Study in Patients with or without Preserved Lower Esophageal Sphincter 2 Years or More after Total Gastrectomy Reconstructed by Roux-en-Y for Gastric Cancer

Background/Aims: Physiological assessments in patients with or without preserved lower esophageal sphincter (LES) after total gastrectomy reconstructed by Roux-en-Y (TGRY) are still inconclusive. This study aims to clarify the significance of LES functions in patients, especially prevention of alkali reflux esophagitis (ARE) after TGRY for gastric cancer. Methodology: Forty-eight patients after TGRY were divided into 2 groups. Group A: 20 patients without preserved LES and group B: 28 patients with preserved LES, and compared with 20 control subjects. The mean follow-up time from operation of TGRY was 27.1 months. Post-operative interview and endoscopic findings for ARE were conducted and esophageal manometry was performed on all patients in order to assess length of LES (LLES; cm) and maximum LES pressure (MLESP; mmHg). Results: Both symptoms and endoscopic findings for ARE in group A were significantly higher than those in group B. The LLES in group A was significantly shorter than that in groups B and C. The MLESP in group A was significantly lower than in groups B and C. Conclusions: ARE after TGRY is due to an impairment of LES functions. Preservation of the LES may be necessary to prevent ARE after TGRY.