الفهرس 
Historical reviewOnly 14 pages are availabe for public view
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Abstract
This study was designed to evaluate the long term outcome of colonic conduit used for esophageal replacement. Three main items were concerned about the neo-esophagus; motility, pathological changes and endoscopic findings all together in terms of clinical picture.
Thirty cases of esophageal replacement were studied regarding clinical and functional outcome. Clinically they showed acceptable quality of life except for some cases who complained heart burn (2 cases/6.7%), dysphagia (5 cases/16.7%), slow transit (5 cases/16.7%), redundancy (3 cases/10%), food impaction (1 case/3.3%) and adhesive intestinal obstruction (2 cases/6.7%). Most of these complications were intermingled with each other, i.e. combined in some cases and solitary in others. Most of complications were managed conservatively.
Regarding the functional part of evaluation of the colonic conduit (neo-esophagus), it was concerning motility, endoscopy and pathological changes on the long run. First, random motility was found in 26 cases (86.7%) in the form of sporadic or regular contractions of the colonic wall. But in order to avoid false positive results, new grading system was created to determine the degree of true peristaltic motility in which percentage of propagated wave was calculated for each case.
Table 6: Grades of motility (New created)
Grade Percentage of propagated waves
0 Absent peristaltic waves
I 1-25%
II 25-50%
III 50-75%
IV >75%
With this accurate grading, motility of the conduit was found to fall in the first three grades (0-I-II) as follows 4cases (13.3%), 15 cases (50%) and 11 cases (36.7%) respectively.
Normal colonic contractions are the consequence of a complex mechanism that involves myogenic, neurogenic and hormonal factors (peristaltic contraction is one of the possibilities). The colon responds to distension of its wall by the bolus of food or fluid, by motility contractions and not to the act of swallow except in some cases where upper segment of esophagus induces peristalsis in response to swallow. Usually these peristalsis are non-transmitted waves. Gravity plays the main role in transportations of food from oropharynx to stomach helped by motility in bulky swallows.
Endoscopic finding were comparable to normal regarding the gross appearance in both upper and lower junctions (25 cases/83.3%). Some abnormalities were seen in the form of cervical anastomosis stricture (2 cases/6.7%), redundancy (3 cases/10%), mucosal ulcer in the lower residual esophagus (1 case/3.3%) and hyperemia (3 cases/10%). Most of the findings can be managed conservatively except for redundancy may need surgical revision.
Pathological changes were minimal regarding the change in position of the colon to thoracic organ in the period of follow up which ranged from 2- 12 years (mean 5.20). Most of the cases were normal (22cases/73.3%). Seven cases (23.4%) showed mild chronic non-specific inflammation of the colonic mucosa, while only one case (3.3%) showed mildly active inflammation of colonic mucosa. It is important to confess on esophagectomy regardless the approach to avoid unnecessary changes in the scarred residual esophagus.
Overall view for colonic conduit is acceptable functionally and clinically.