High-Resolution Manometry Reveals Normal Esophageal Motility, Including Lower Esophageal Sphincter Function, After Vagus Nerve-Preserving Gastrectomy

Objective: We developed two new methods to preserve lower esophageal sphincter (LES) function and the vagus nerve in performing total gastrectomy (TG) and partial cardiectomy (PC) for patients with early-stage gastric cancer. We used two methods compared to standard TG and evaluated outcomes using high-resolution manometry (HRM) to analyze esophageal function. Methods: We used HRM to evaluate 38 patients who underwent gastrectomy between April 2012 and September 2015. Nine, 13, and 16 patients underwent standard TG (Group A), LES and vagus nerve-preserving (LES-VNP) TG (Group B), and LES-VNP-PC (Group C), respectively. The differences among the mean values of DCI, IRP, CFV, and LESP were evaluated using Student’s ttest. In addition, post-hoc sample analysis was performed. Results: LES function and normal peristalsis of the esophagus were observed in 9 of 13 patients in Group B. LES pressure (LESP) was observed in all but 1 patient, and 6 in Group C exhibited normal LESP. Normal peristalsis was observed in 11 patients, although weak or failed contraction was observed in 5 patients each, respectively. In contrast, 1 of the 9 patients in Group A exhibited normal LESP. Normal peristalsis of the esophagus was observed in 6 patients, although the distal contractile interval was less than the normal range. Furthermore, in 3 patients each, weak or no contraction of the esophagus was observed. The LESP in Group B and Group C was significantly higher compared with that in Group A (p= 0.0275, 0.007, respectively). There were no significant differences in the values of the other variables between groups. In post hoc analysis, there were no significant differences between Group A and Group B only in CFV (p=0.0345). Conclusion: Our new technique shows promise for preserving LES function as well as esophageal peristalsis.