Effect of Pancreatic Juice and Bile Reflux to the Development of Esophageal Carcinogenesis in Rat Model

Background Reflux of duodenal contents contributes to the development of esophageal mucosal lesion. Esophageal cancer after gastrectomy has been associated with the reflux of duodenal content (biliary and pancreatic juice) into the esophagus. This study is to determine which fraction of the duodenum content, pancreatic juice or bile acids, contributes to the development of esophageal cancer. Methods 8 week Wistar rat were used.1.Reflux of Pancreatic juice and Bile (TG): End-to-end esophago-duodenostomy with total gastrectomy (n = 27) 2. Reflux of Pancreatic Juice (TG + B):End-toend esophago-duodenostomy with total gastrectomy. Then, a bypass operation of the upper bile duct was made 25 cm below the esophagoduodenostomy anastomosis to produce only pancreatic reflux. Choledocho-jejunostomy was performed (n = 12). 3. Sham group (n = 5). Forty weeks after operation, all rats were sacrified and the esophagus was evaluated histologically.Esophageal injury was evaluated by macroscopic and microscopic findings. Results 1.Macroscoping finding; In TG rats, the esophageal wall was thickened and sever inflammation. There was a small polypoid tumor in the lower esophagus in TG.But TG + B was not sever inflammation, moreover the esophagus of TG + B did not reveal any pathological findings. 2.Microscopic findings:In TG,we detect erosion (100%),regenerative hyperplasia (100%),CLE (40%) sever dysplasia (100%)SCC (40%) and ADC (30%).In TG + B, we detect erosion (0%),regenerative hyperplasia (100%),CLE (0%),mild dysplasia (40%),SCC (0%),and ADC(%). Conclusion The reflux of pancreatic juice alone is probably not significant development of esophageal cancer after total gastrectomy compared to the reflux of bile and pancreatic juice. Pancreatic juice reflux appears to exert a co-carcinogenic effect when combined with bile.