Colonic pouch vs. side-to-end anastomosis in low anterior resection.

PURPOSE: Colonic pouches have gained increasing popularity in reconstruction after low anterior resection. In this prospective, randomized trial colonic pouch reconstruction is compared with side-to-end anastomosis for functional outcome. METHODS: From October 1995 to October 1996, 29 patients had colonic pouch and 30 patients had side-to-end anastomosis reconstruction after low anterior resection. Patients were matched for age, gender, and tumor stage and localization. All patients underwent functional evaluation preoperatively and at three and six months postoperatively. RESULTS: There was no difference in preoperative anorectal function. The operating time was higher in the colonic pouch group (167 vs. 149 minutes). Twenty-three patients (79.3 percent) with colonic pouch had a protective stoma compared with 21 patients (70 percent) with side-to-end anastomosis. Postoperative complications were 10.3 and 13.3 percent, respectively. There was no difference in manometric pressure of the anus, in anorectal angle, and in continence status after three and six months. Stool frequency was higher in the side-to-end anastomosis group, with 2.2 vs. 5.4 per day at three months and 2.3 vs. 3.1 per day at six months. Constipation was noted in two patients with colonic pouch (7 percent) and none in the side-to-end anastomosis group at three months and two vs. none at six months. Maximum tolerated volume and threshold volume was higher in the colonic pouch group at three and at six months. CONCLUSION: Both forms of reconstruction have similar satisfactory long-term functional results. The major advantage of colonic pouch was seen in the immediate postoperative phase.

Intramural pseudodiverticulosis of the esophagus: a case series.

Intramural pseudodiverticulosis of the esophagus is a rare benign disease of the esophageal wall, with dilation of the submucosal glands, and the predominant symptom is dysphagia. In the literature, 191 cases have been described so far. Along with a short review of the literature, the present report describes six cases of this disorder, including a patient in whom intramural pseudodiverticulosis of the esophagus was secondary to laser therapy and endoluminal afterloading of an esophageal squamous-cell carcinoma.

Adenocarcinoma of the gastro-esophageal junction: CT for monitoring during neoadjuvant chemotherapy.

OBJECTIVE: A clinical study was performed to assess the diagnostic value of spiral CT for evaluation of response during neoadjuvant chemotherapy (CTx) in patients with adenocarcinoma of the gastro-esophageal-junction (GEJ). Results were compared to those of endoscopy. METHODS AND MATERIAL: Twenty-five patients with histologically proven adenocarcinoma of the GEJ scheduled to undergo neoadjuvant CTx were studied. Before CT examination, 1200 ml of a vanilla flavoured paraffin emulsion were applied orally to the fasting patients and 40 mg BuscopanR or 2 mg glucagon were injected i.v. for hypotonia. Iodine (100 ml) was injected automatically (3 ml/s) and the CT scan was started 10 s after complete administration of CM. For response evaluation to CTx, four standardized parameters were measured by two experienced, blinded radiologists. The results were categorized according to the WHO classification of 1981 and compared to those of endoscopy. RESULTS: In 24 of 25 patients endoscopic and computed tomographic response evaluation showed a close correlation (r = 0.96). CONCLUSION: Spiral CT with negative oral contrast agent is a suitable technique for monitoring of GEJ masses. In combination with standardized metric parameters it offers a quantitative response evaluation in patients with GEJ masses during neoadjuvant CTx.