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Institution: Alfred Health - Victoria, Australia
Purpose: Physiological function, anatomy and emptying of the gastric conduit are important in mediating gastrointestinal symptoms and quality of life post oesophagectomy. Anatomy, peristalsis and transpyloric flow are incompletely defined. We aimed to analyse gastric conduit function using dynamic MRI to evaluate dynamic anatomy, peristaltic function and emptying.
Methodology: Eighteen conduits and 12 controls were recruited. Peristalsis variables including Gastric Motor Index (GMI) were measured at 4 time points throughout the MRI, and volume scans were taken at the beginning and end of the 20-minute scanning period. Quality of Life questionnaire data was collected.
Results: Nine(50%) conduits demonstrated coordinated peristalsis, 3(16.7%) no peristalsis and 6(33.3%) incoordinate peristalsis. Regarding conduits vs controls, there was no difference in peristaltic wave frequency (5 vs 5) or GMI (35.45 vs 36.5,p=0.61), but emptying was slower (0.10% vs 15% p=0.01). Acute angulation was associated with slower emptying (444 vs 127 min, p=0.025). Conduit width and location of the pylorus relative to the hiatus made no significant difference. Quality of life scores were significantly better in controls compared with conduits.
Conclusion: Many conduits demonstrated peristalsis, but no relationship was found between peristalsis and conduit emptying, whereas conduit shape and placement within the mediastinum were significant. Impaired emptying in the presence of gastric body peristalsis appeared centred at the pylorus and this differentiated conduits from controls. Dynamic MRI is a promising research and diagnostic tool to assess conduit function due to its capacity to accurately delineate the key elements of conduit function.
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Dr Kaleb Lourensz - , Dr Yazmin Johari - , Dr Shalini Bigwood - , Dr Paul Beech - , Dr Geoff Hebbard - , Dr Paul Burton - , Professor Wendy Brown -