Motor function in the excluded esophagus and its implications in the management of patients with unresectable carcinoma of the esophagus

Palliative exclusion of the esophagus by use of transposed stomach was performed in a 63-year-old woman with unresectable cervical esophageal cancer. Twelve weeks after this operation, motor function of the excluded esophagus was assessed. All voluntary swallows produced a motor response in the esophageal body. Eighty-five per cent of the contractions were peristaltic and generated mean pressures of 28 mmHg. Fifteen per cent of the deglutitions were followed by nonpropulsive waves with mean pressures of 24 mmHg. Spontaneous tertiary activity occurred at a rate of 2.5 contractions per minute with an amplitude of 16 mmHg. Motor function in the excluded esophagus persists after bypass of the organ. This suggests that the excluded esophagus should be decompressed after surgery to prevent "blowout" of its closed ends.