IJMS Summer - CiteSeerX

IJMS Journal Spring 2003

23/2/04

9:39 am

Page 9

original paper

Effect of tumour and chemoradiotherapy on oesophageal motility

Effect of tumour and chemoradiotherapy on oesophageal motility S Tormey1, A Nasyr1, DA McNamara1, PJ Byrne2 TN Walsh1 RCSI Department of Surgery, James Connolly Memorial Hospital1 and St James’s Hospital2, Dublin, Ireland.

Abstract Background The contribution of dysmotility to dysphagia in oesophageal cancer is unclear. Aim To examine oesophageal motility in patients with oesophageal carcinoma and to assess the effect of chemoradiotherapy on motility. Methods Stationary manometry and 24-hour pH-metry were performed in 12 patients with oesophageal carcinoma and one week following completion of chemoradiotherapy using 5-fluorouracil (5-FU), cisplatin and 40Gy radiotherapy. Results All patients had abnormal motility prior to treatment. Peristalsis was impaired in 11 patients with a mean (SD) of 25% (9) of waves normally propagated. Eight patients had 20% or more simultaneous waves. Following chemoradiotherapy, the percentage of waves normally propagated increased from 25% (9) to 52% (10) (p76 years of age and those with tumours deemed too bulky at endoscopy to permit passage of pH or manometry probes were excluded from the study. A symptom history was taken at presentation and following completion of treatment.

Irish Journal of Medical Science • Volume 172 • Number 1

Manometry Study patients underwent 24-hour pH monitoring and stationary manometry prior to treatment and again one week following completion of a 6-week chemoradiotherapy regimen. Patients were fasted overnight and all medication was discontinued for at least 48 hours prior to study. Proton pump inhibitors were discontinued for seven days prior to study. Oesophageal manometry was performed as previously described.6 Briefly, this was carried out using a four-lumen single catheter assembly, with radially arranged side holes at 5cm intervals. Each channel was perfused with distilled water at a rate of 0.06ml per minute using an Arndofer low compliance pneumohydraulic infusion system. Oesophageal body function was assessed in response to 10 wet swallows of 5ml boluses of water at least 30 seconds apart.

Twenty-four-hour pH monitoring Twenty-four hour pH studies were performed with an antimonytipped pH probe and recorded using a digitrapper (Synectics Medical, Sweden) with the sensor placed 5cm above the LOS as previously described.7

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IJMS Journal Spring 2003

23/2/04

9:39 am

Page 10

S Tormey et al

Definitions of motility patterns Motility was normal when >90% of waves were normally transmitted in response to 10 wet swallows, each of 5ml of water. Dysmotility was expressed in terms of disorders of progression and disorders of contraction as defined by deMeester8 and briefly outlined below. Disorders of progression were abnormally propagated waves, simultaneous waves and non-transmitted waves while certain disorders of contraction occurred when waves were interrupted, dropped or isolated. Propagated waves began in the pharynx in response to a documented wet swallow and progressed all the way to the cardia to be registered sequentially on all sensors. These waves had an amplitude of >20mmHg and a velocity of 20cm/sec. Non-transmitted waves had an amplitude of 10mmHg in the proximal and 20mmHg in one channel and