Characterization of gastric conduit electrophysiology in postesophagectomy patients using high-resolution body surface gastric mapping.

BACKGROUND

Esophagectomy with gastric conduit reconstruction is associated with long-term morbidity; however, the mechanisms underlying postoperative gastric dysfunction remain incompletely understood. This study evaluated gastric myoelectrical activity in the reconstructed intrathoracic stomach using noninvasive body surface gastric mapping (BSGM) and examined its relationship with symptoms and delayed gastric conduit emptying (DGCE).

METHODS

A total of 30 adults at a median of 50.4 months postesophagectomy were recruited and compared with 30 matched controls. All participants underwent BSGM. Patient-reported outcomes were assessed using the Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM), Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QoL), total symptom burden score, and Konradsson's DGCE score. Electrophysiological metrics were compared with those of matched controls. Pearson correlations and analysis of variance with correlation ratio were used to assess associations among electrophysiology, symptoms, and DGCE.

RESULTS

Postesophagectomy patients demonstrated significantly impaired gastric electrophysiology, including reduced principal gastric frequency (2.65 ± 0.37 vs controls, 3.11 ± 0.24 cycles per minute, P <.001) and body mass index (BMI)-adjusted amplitude (27.1 ± 11.1 vs 40.5 ± 17.3 µV, P <.001). Notably, 23 (76.7%) patients exhibited abnormal BSGM phenotypes, most commonly low-frequency activity (n = 13). DGCE was present in 23.3% of patients and was associated with a higher symptom burden and reduced quality of life (PAGI-SYM, r = 0.37, P <.05; PAGI-QOL, r = -0.41, P <.05). Principal gastric frequency was found to correlate with nausea (r = 0.49, P <.05), and BMI-adjusted amplitude correlated with symptoms of excessive fullness (r = 0.49, P <.05) and upper gut pain (r = 0.48, P <.05).

CONCLUSION

The gastric conduit exhibits persistent electrophysiological abnormalities years after esophagectomy, characterized by low-frequency slow-wave activity and reduced amplitude. Although these abnormalities showed some association with symptom burden, they did not correlate with DGCE, indicating that this condition is multifactorial. BSGM provides insight into postesophagectomy gastric function and could inform therapeutic strategies.