Delineating gastric emptying after major gastro-oesophageal surgery using real time MRI

Background:: Optimising gastric conduit emptying post oesophagectomy is key to improving morbidity outcomes in a cohort of patients with increasingly long survivorship. It is thought that peristaltic function and resultant emptying of the gastric conduit improves over time. However, the relationship between peristalsis and conduit emptying has not been precisely delineated, nor has the presumed recovery. Aims:: In this study, we aim to investigate dynamic MRI as a technique to measure gastric conduit peristalsis in the mediastinum. We will use it to quantify the degree of peristalsis in the established gastric conduit and assess its correlation with emptying. We will also use quality of life and adverse symptom questionnaires to look for a relationship between peristalsis and gastrointestinal quality of life. Hypothesis: Dynamic MRI is an accurate way to measure gastric conduit peristalsis and conduit emptying. Peristaltic activity recovers post oesophagectomy and is more effective in narrower conduits. Brief Methods: Post oesophagectomy patients will be recruited greater than 2 years post oesophagectomy. Dynamic MRI will be performed, and questionnaires and demographic data collected Patients greater than 2 years post oesophagectomy and gastric conduit reconstruction will be prospectively recruited. Static and Dynamic MRIs will be performed in the supine position post consumption of a semisolid meal. Speed, length, and amplitude of peristaltic waves will be measured at 4 time points over a 20-minute period. Gastric Motility Index mm2/s (GMI) will be calculated (velocity x amplitude of peristaltic wave). Gastric conduit volumes will be calculated at the start and end of each MRI.