Morphological state of the mucous membrane of the esophagus of patients with post-resection manifestations of reflux esophagitis depending on the method of the formation of mechanical esophagus-gastric anastomosis
Authors: Usenko O.U. , Sidyuk A.V. , Klimas A.S. , Sidyuk O.E. , Savenko G.U. 
Published: March 2019

The formation of mechanical gastrointestinal anastomosis after esophagectomy is often accompanied by the development in patients various degrees of reflux esophagitis. The aim of the study – to evaluate the pathogistological changes of the esophagus mucosa associated with gastro-esophageal reflux in patients with esophageal cancer and gastroesophageal, junction cancer after surgical treatment, depending on the technique of forming the esophagus-gastric anastomosis. The study included 30 patients who developed a mechanical invagination of the esophagus-gastric anastomosis developed by the Ukrainian patent (study group) and 30 patients who formed the end-to-end mechanical circulatory esophagus-gastric anastomosis (comparison group). At 12 months of observation all patients were given fibroesophagogastroduodenoscopy. Endoscopic diagnosis of esophagitis was performed according to a modified Los Angeles classification. To assess the morphological state of the esophageal mucosa, the esophageal mucosal biopsy was performed on the site of anastomosis and morphologically evaluated the severity of the reflux esophagitis. Reflux-associated changes in squamous epithelium of the esophagus were evaluated according to the consensus recommendations of the Esohisto Project. Statistical data analysis was performed using the EZR v statistical analysis package. 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical interface to R (The R Foundation for Statistical Computing, Vienna, Austria). In a comparative analysis of frequency characteristics between different groups of patients, the c2 criterion was used; for tables 2´2 (in the case of a small number of patients (<5 cases), in the study subgroups) Fisher’s exact test was used. The differences in the results obtained were considered statistically significant at p<0.05, which ensures a 95% level of probability. It has been established that the frequency with which the microscopic signs of reflux esophagitis are fixed are almost 2 times lower in the group of patients who were formed mechanical invagination esophagus-gastric anastomosis in comparison with the mechanical circular (46.7% vs. 83.3%, p<0.05), since invagination simulates the reproduction of antireflux properties of the lost gastrointestinal transition. Endoscopically diagnosed cases of reflux esophagitis are additionally supplemented by microscopically detected from 5.9% of subjects in the study group to 28.6% of subjects (p<0.05) in the comparison group, which indicates a higher sensitivity histological diagnosis. The signs that are consistently associated with post-resection reflux esophagitis include hyperplasia of the basal layer at both the frequency (86.7% vs. 100%) and the severity of the severity (6.7% vs. 23.3%, p<0.05), as well as moderate prolongation of papillae (30.0% vs. 66,6%, p<0.01), according to which the best results were obtained in the group of patients that formed the invagination mechanical esophagus-gastric anastomosis. According to the Esohisto Project criteria, the frequency of both “mild” and “severe” esophagitis in the group of patients that formed the invagination mechanical esophagus-gastric anastomosis was lower compared to the group with mechanical circulatory esophagus-gastric anastomosis (36.7% and 10.0% vs. 63.3% and 20.0%, p<0.01, respectively).