Gastroesophageal reflux disease after esophagectomy—a narrative review

Background and Objective: Esophagectomy and subsequent gastrointestinal tract reconstruction provide treatment for both benign and malignant diseases. It can be performed by open and minimally invasive esophagectomy (MIE) techniques with either trans-thoracic (TT) or trans-hiatal (TH) approaches. Regarding the intrinsic differences of each procedure, some postoperative complications are highly common in all types of esophagectomy. Gastroesophageal reflux disease (GERD) is one of the most common postoperative complications of esophageal resection. This review aims to discuss reflux after esophagectomy and its correlation to the surgical technique adopted, the pathophysiological mechanisms involved, its clinical impact, as well as the strategies for diagnosis, preventing measures and clinical or surgical treatment options. Methods: The authors performed a narrative review evaluating the reflux after esophagectomy. Key Content and Findings: The causes for its occurrence are multifactorial, including loss of anti-reflux mechanisms and other hypothetical mechanisms. There is no consensus regarding the diagnostic methods and when to start the reflux investigation after esophagectomy. Nevertheless, the initial assessment should be performed with endoscopy. Further diagnostic evaluation with pH-metry or impedance monitoring is not routinely indicated, given the absence of standardization of the positioning of the pH-metry catheter. In order to avoid its occurrence, both intraoperative and postoperative measures should be adopted to mitigate the risks of postoperative gastroesophageal reflux. Understanding risk factors and aspects of surgical technique may decrease the impact of this complication. This review discusses reflux after esophagectomy and its correlation to the surgical technique adopted, the pathophysiological mechanisms involved, its clinical impact, the strategies for investigating this condition, and the measures to prevent and treat it. Conclusions: Gastroesophageal reflux after esophagectomy is a common complication, demanding complex management. Understanding the pathophysiological mechanisms, the clinical impact, its diagnosis and prevention and treatment options may help reduce its morbidity.