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PubMed1994

Ten-year follow-up of a prospective, randomized trial of selective proximal vagotomy with ulcer excision and partial gastrectomy with gastroduodenostomy for treating corporeal gastric ulcer.

Between 1975 and 1980, 30 patients with type I corporeal gastric ulcer were randomly allocated to undergo selective proximal vagotomy with ulcer excision or partial gastrectomy with gastroduodenostomy. Sixteen patients underwent selective proximal vagotomy (1 was excluded from the follow-up since microscopic examination of the excised ulcer revealed an early gastric cancer) and 14 underwent partial gastrectomy. No significant differences in the clinical results were found 3 years after surgery. During a median follow-up of 10 years, ulcer recurred in 3 patients after selective proximal vagotomy and in 2 after partial gastrectomy. One patient in each group had recurrent ulcer without symptoms and received no treatment. Two selective proximal vagotomy patients and three partial gastrectomy patients had epigastric pain with or without ulcer. One patient with selective proximal vagotomy underwent a second operation because of epigastric pain and recurrent ulcer. Bowel habits remained unchanged in all but one patient in each group, and mild or moderate dumping was recorded for two patients in each group. Very good or good results (modified Visick scale) were recorded for 11 of 15 patients after selective proximal vagotomy and for 10 of 14 patients after partial gastrectomy. Except for one patient in each group who had moderate dumping, patients classified as Visick III or IV had no symptoms during treatment with antacids or H2-blockers, or had asymptomatic ulcers and needed no treatment. Selective proximal vagotomy reduced the median acid response to insulin hypoglycemia and to pentagastrin by 100% and 80%, respectively, for at least 3 to 5 years, and partial gastrectomy reduced the median acid response to pentagastrin by 97%. In our opinion, selective proximal vagotomy with ulcer excision is an alternative to partial gastrectomy for surgically treating type I gastric ulcer.

Duodenostomy↗
PubMed2006

Comparison of laparoscopic and open gastrectomy for gastric cancer.

BACKGROUND: The role of minimally invasive gastrectomy in the treatment of gastric cancer is not well defined. The aim of the current study was to compare the operative outcomes and adequacy of resection of laparoscopic gastrectomy compared to open gastrectomy for gastric cancer. METHODS: The clinical course of 15 consecutive patients who underwent minimally invasive gastrectomy or esophagogastrectomy for gastric cancer were compared with that of 21 patients who underwent open gastrectomy. Main outcome measures included operative time, blood loss, length of stay, morbidity, 30-day mortality, and adequacy of lymphadenectomy and resection margins. RESULTS: There was no conversion to laparotomy in the laparoscopic group. Intraoperative blood loss was significantly lower in the laparoscopic group (138 mL vs. 357 mL). There was no significant differences in the mean operative time (244 vs. 241 min.), transfusion rate (6% vs. 29%), median length of stay (6 vs. 7 days), morbidity (7% vs. 24%), or number of lymph nodes harvested (15 vs. 14 nodes) between the 2 groups. Resection margins were negative in all patients. There were no leaks and the 30-day mortality was 0 in both groups. Anastomotic strictures were higher in the laparoscopic patients. CONCLUSION: Laparoscopic gastrectomy is feasible and can be performed safely with adequate lymphadenectomy compared with open gastrectomy.

Aged↗
PubMed2006

Early and late gastric cancer arising in the remnant stomach after distal gastrectomy.

AIM: Following distal gastrectomy, carcinogenesis has been suggested to result from gastroduodenal reflux. In this study, surgical cases of gastric cancer arising after distal gastrectomy were analyzed clinico-pathologically and the possible link to reflux examined. PATIENTS: Thirty-two patients (24 males, 8 females; mean age, 68.7 years; age range, 33-84 years) with gastric cancer arising in the remnant stomach after gastrectomy (also known as gastric stump cancer) were included in this study. Patients were divided into two groups on the basis of the initial diagnosis (benign or malignant) prompting surgery, and distal gastrectomy reconstruction method (Billroth I or II). RESULTS: The interval between distal gastrectomy and detection of cancer in the remnant stomach of patients treated initially for a benign gastric condition vs. malignancy was 360+/-33.04 and 63+/-19.16 months (median+/-SE), respectively (p<0.0001). However, the benign and malignant groups did not differ significantly in the clinicopathological analysis of their stump cancers. All 10 patients in whom gastric cancer was diagnosed within five years of initial surgery had initially been surgically treated for malignancy. The interval between surgery and detection of gastric cancer in the Billroth I and Billroth II groups was 84+/-26.67 and 276+/-44.26 months (median+/-SE), respectively (p<0.01). In the remnant stomach, cancer tended to occur near the site of gastrojejunostomy in the Billroth II group (p=0.05). Helicobacter pylori infection was only detected histologically in four patients who had undergone Billroth I reconstructions after distal gastrectomy for malignancy. CONCLUSION: After distal gastrectomy, careful periodic endoscopic examination for microcarcinoma is required in patients, particularly in those who undergo surgery for malignancy, to maximize detection of gastric cancer.

Adult↗
PubMed1996

End results of simultaneous splenectomy in patients undergoing total gastrectomy for gastric carcinoma.

BACKGROUND: Splenectomy often is performed simultaneously with total gastrectomy for gastric carcinoma to facilitate dissection of splenic hilar lymph nodes. Splenectomy, however, should be avoided as frequently as possible because of its important role in the reticuloendothelial system and because of its sometimes severe complications. We evaluated the end results of simultaneous splenectomy with total gastrectomy. METHODS: The effect of splenectomy on survival was examined by retrospective analysis of 245 patients undergoing total gastrectomy for gastric carcinoma. Of these, 154 underwent splenectomy, and 91 did not. Prognostic factors for patients undergoing total gastrectomy were determined. The relationship to postoperative complications also was analyzed. RESULTS: No significant differences overall were found between the 5-year survival of the patients undergoing total gastrectomy with or without splenectomy. No correlation to any prognostic factor was seen with splenectomy. In contrast, splenectomy was independently associated with postoperative complications. CONCLUSIONS: In this retrospective study simultaneous splenectomy at total gastrectomy for gastric cancer did not have an effect on the survival rate of patients undergoing total gastrectomy, and it sometimes caused severe complications.

Female↗
PubMed2000

Distal gastrectomy and Roux-Y limb in the rat: plasma motilin, pancreatic polypeptide concentrations, and duodenojejunal motility.

After gastrectomy, Roux-Y limb reconstruction leads to duodenojejunal motor disturbances. Because motilin and pancreatic polypeptide (PP) play a role in the regulation of digestive motility, their plasma concentrations were determined in rats after Roux-Y gastrectomy. Three months after a distal Roux-Y gastrectomy, coupling of electromyographic recordings and jugular samples were used to perform motilin and PP radioimmunoassays during and between activity fronts (AFs) occurring in the limb and in the duodenojejunum, 20, 40, and 60 min after intragastric instillation of a standard meal (5 ml Realmentyl). Animals that underwent a simple laparotomy, animals having isolated jejunal transection, and animals with Billroth I gastrectomy (BI group) served as control groups. After Roux-Y gastrectomy, the number of AFs in the limb (P < 0.01) and in the duodenum (P < 0.001) was reduced compared to laparotomized rats and the BI group, but did not differ from the number in the Tr group. In the limb, AFs were incompletely propagated or were retrograde in 9 and 3 of 20 animals, respectively. After Roux-Y gastrectomy, motilin concentrations occurred at the same time as each duodenal AF, and as in controls, and were independent from AFs in the limb. Plasma motilin concentrations were higher after Roux-Y reconstruction than in control groups (P < 0.03), and PP level concentrations were not different. After the meal, the interruption of AFs was shorter in Roux-Y reconstruction than in laparotomized and transected animals (P < 0.05) and than in BI group, with no significant difference in the latter. In all groups, plasma motilin and PP concentrations were decreased (P < 0.05) and increased (P < 0.001), respectively, after the meal compared to the interdigestive period. After Roux-Y gastrectomy, plasma motilin and PP levels were higher (P < 0.05) and lower (P < 0.05), respectively, compared to controls. In conclusion, AFs in the Roux-Y limb were not associated with plasma motilin concentrations, suggesting a lack of influence of motilin on the interdigestive motor status. The decrease in postprandial plasma PP concentrations may play a role in the shorter interruption of AFs after a meal.

Anastomosis, Roux-en-Y↗
PubMed2003

Feasibility and safety of percutaneous endoscopic gastrostomy in patients with subtotal gastrectomy.

BACKGROUND AND STUDY AIMS: We aimed to study the technical feasibility, safety, efficacy and complications of endoscopic feeding tube placement in patients who had previously undergone subtotal gastrectomy. We also investigated whether jejunal feeding tube placement (percutaneous endoscopic jejunostomy [PEJ]) is superior to gastric feeding tube placement (percutaneous endoscopic gastrostomy [PEG]) in the prevention of aspiration pneumonia in patients with subtotal gastrectomy. PATIENTS AND METHODS: A retrospective cohort study was carried out which included 48 patients treated between 1995 and 2001. Participants were selected from 3400 patients who were referred for PEG placement. The study group consisted of 15 consecutive patients with a prior subtotal gastrectomy. The control group comprised 33 randomly selected patients with intact stomachs. The primary end point of the study concerned the safety of PEG placement. The secondary end points included the efficacy and technical difficulty of the procedure. RESULTS: PEG/PEJ placement was successful in 14 of the 15 patients (93 %) who had previously had a subtotal gastrectomy. None of the study patients developed procedure-related complications. Feeding intolerance was more common in patients with gastrectomy compared with patients with an intact stomach, but the difference did not reach statistical significance (10 % vs. 3 %, P>0.05). A significantly higher incidence of pneumonia was observed in patients with gastrectomy compared with patients with an intact stomach (P=0.01). Subgroup analysis showed that the risk was higher with jejunal tube placement compared with gastric tube placement (42 % vs. 12 %, P=0.001). CONCLUSION: PEG/PEJ placement in patients with gastrectomy is a technically safe procedure. These patients are at higher risk of aspiration pneumonia and risk is higher with jejunal tube placement compared with gastric tube placement.

Aged↗
PubMed1997

Role of endogenous somatostatin in postprandial hypersecretion of neurotensin in patients after gastrectomy.

OBJECTIVE: The purpose of this report is to elucidate the mechanism of the hypersecretion of neurotensin (NT) after gastrectomy. SUMMARY BACKGROUND DATA: NT secretion induced by fat ingestion is increased after pancreatoduodenectomy or distal gastrectomy. The hypersecretion of NT in the patients undergoing resection of the upper gastrointestinal tract is suppressed by an exogenous somatostatin (SST) analog. METHODS: We observed simultaneously the secretion of NT and SST in the same patients before and after gastrectomy (n = 7). We also observed the secretion of these hormones induced by intraduodenal (ID) fat infusion in the normal volunteers (n = 6). RESULTS: The response of plasma NT to fat ingestion was significantly increased after gastrectomy compared with that before gastrectomy. The response of plasma SST after gastrectomy was significantly suppressed. The response of plasma NT and SST after ID fat infusion in the normal volunteers was similar to the gastrectomized state. CONCLUSION: Diminution of SST secretion, probably caused by the lack of SST cells in the distal part of the stomach, may play a role in augmenting NT secretion after gastrectomy.

Aged↗
PubMed1989

Gastric emptying after partial gastrectomy without vagotomy with primary Roux-en-Y or Billroth II anastomosis.

Several clinical studies have indicated that gastric emptying is delayed in patients with Roux-en-Y biliary diversion with vagotomy. In order to determine whether Roux-en-Y diversion without vagotomy also induces delayed gastric emptying, we have compared the effect of gastrectomy without vagotomy with either Billroth II or Roux-en-Y anastomosis on gastric emptying of a liquid and solid meal in 22 peptic ulcer patients. The emptying half-times (t1/2) for solid food were not significantly different, 54; 24-122 min (median and range) in the 11 patients with Billroth II gastrectomy, 68; 44-189 min in the 11 patients with Roux-en-Y gastrectomy, and 83; 27-114 min in 11 normal control subjects. However, the lag phase was significantly (p less than 0.01) shorter in the patients with Billroth II gastrectomy (5; 0-43 min) and Roux-en-Y gastrectomy (4; 2-12 min) than in the control subjects (10; 4-22 min). The t1/2's for the fluid meal were similar, 7; 4-49 min after Billroth II gastrectomy, 8; 4-32 min after Roux-en-Y gastrectomy, and 9; 3-20 min in the control subjects. In all subjects the lag phase for the fluid meal was very short, ranging from 0 to 3 min. It is concluded that Roux-en-Y diversion per se does not delay gastric emptying in man.

Anastomosis, Roux-en-Y↗
PubMed2006

Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study.

BACKGROUND: Curative gastrectomy is a promising approach for the treatment of gastric cancer; however, the optimal extent of lymph node dissection for advanced cancer remains controversial. The aim of this multi-institutional study was to evaluate the feasibility of D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric cancer. The surgical results of D2 and D3 gastrectomy (para-aortic lymph node dissection) were retrospectively compared. METHODS: A series of 580 advanced gastric cancer patients were registered between 1992 and 2000. Of these, 430 underwent D2 gastrectomy and 150 underwent D3 gastrectomy. Survival time, prognostic factors, postoperative morbidity/mortality, and pattern of recurrence were compared. RESULTS: There was no significant difference in survival time between D2 and D3 patients. However, the survival times of D3 patients with tumor diameters measuring 50 to 100 mm or with pN1 disease were significantly longer than those of the corresponding D2 patients. Analysis of the survival of patients with tumor diameters measuring 50 to 100 mm revealed that D3 gastrectomy conferred a survival advantage only to patients with pN2 disease. The incidence of lymphatic recurrence was lower in D3 patients with 50- to 100-mm tumors than in the corresponding D2 patients. CONCLUSIONS: D3 gastrectomy might be beneficial in patients with advanced pN2 gastric cancer within the group with tumors measuring 50 to 100 mm. A randomized controlled trial of patients with 50- to 100-mm tumors should be performed to test the validity of this preliminary result.

Aged↗
PubMed1999

[The affect of Helicobacter pylori and bile acids as the pathogenesis of gastritis of the remnant stomach after distal partial gastrectomy].

AIMS: After distal partial gastrectomy with Billroth I reconstruction, gastritis of the remnant stomach was previously considered to be caused by bile reflux. However, since in 1982, Helicobacter pylori (HP) was discovered and it was found that this organism caused for many types of stomach diseases. The affect of HP must also be examined in the remnant stomach. In a current study, we examined the existence of HP and explored bile reflux as a pathogenesis of gastritis of the remnant stomach after distal partial gastrectomy. PATIENTS AND METHODS: The subjects were 56 patients who underwent gastrectomy. The existence of HP was investigated before and after gastrectomy. At postoperative gastroscopy, we examined histological findings of remnant gastritis and total bile acid (TBA) concentration in the gastric juice. Then we assessed the effect of HP and TBA on gastritis regarding the time after gastrectomy. RESULT: HP was positive in 75% of the patients before the operation and in 37.5% after the operation. The HP positive ratio was significantly lower in patients more than 5 years after gastrectomy than in those within 5 years. Inflammatory cell infiltration of the remnant gastric mucosa was more prominent in HP positive patients than in HP negative patients. In HP positive remnant stomachs, the TBA concentration of the gastric juice was lower than in HP negative remnant stomachs. CONCLUSION: Within 5 years after distal partial gastrectomy, gastritis of the remnant stomach was mainly caused by HP.

Adult↗
PubMed2000

Influence of gastrectomy on the distribution of intravenously administered 5-fluorouracil to regional lymph nodes in an animal model.

BACKGROUND: Neoadjuvant and postoperative chemotherapies have been widely employed for the treatment of patients with gastric carcinoma. However, to the authors' knowledge there have been no studies that focused on pharmacokinetic differences between antineoplastic agents administered before versus after gastrectomy. The influence of gastrectomy on the distribution of antineoplastic agents, especially to the regional lymph nodes, were examined. METHODS: Twelve pigs were divided into 2 groups of 6 each (i.e., those with and without total gastrectomy). Under general anesthesia, 10 mg/kg of 5-fluorouracil (5-FU) was injected rapidly. Total gastrectomies were performed before these injections in the group that underwent gastrectomy. In both groups a lymph node at the root of the left gastric artery (1), a preaortic lymph node (2), and venous blood were sampled in 3 animals at 15 minutes and in another 3 animals at 60 minutes after the 5-FU injection. The 5-FU concentrations in these samples were determined by high performance liquid chromatography. RESULTS: The 5-FU concentrations of 1, 2, and plasma at 15 minutes/60 minutes after injection in the nongastrectomized group were 7.75 x 10(3)/227 ng/g, 7.58 x 10(3)/439 ng/g, and 7.24 x 10(3)/417 ng/mL, respectively. The corresponding concentrations in the gastrectomized group were 6.04 x 10(3)/211 ng/g, 5.80 x 10(3)/206 ng/g, and 5.76 x 10(3)/229 ng/mL, respectively. There were no differences in 5-FU concentrations among any of the lymph nodes or the plasma, regardless of whether gastrectomy was performed. CONCLUSIONS: No influence of gastrectomy on the distribution of 5-FU to the regional lymph nodes was observed in animal models in the current study.

Animals↗
PubMed2000

Immunohistochemical and statistical studies on the islets of Langerhans pancreas in autopsied patients after gastrectomy.

We describe in detail the pathologic features of the islets of Langerhans in specimens of the pancreas from 75 autopsy specimens of patients who underwent gastrectomy and compare them with specimens from 22 patients not having gastrectomy with respect to the duration of the postoperative period and the operative procedure. In comparison with the control group, the islets of Langerhans from the gastrectomy patients showed hyperplasia and increased numbers of endocrine cells within 5 years of gastrectomy but atrophy and decreased numbers of endocrine cells thereafter. These changes are compatible with anti-insulin immunoreactivity (B-cells) in the islets of Langerhans, where B-cell counts correlated with the area of the islets. The proliferating cell nuclear antigen (PCNA)-positive cell ratio in the islets was higher during the early phase after gastrectomy, whereas the apoptotic cell ratio was not affected by the time after gastrectomy. Hyalinization of the islets of Langerhans was first recognized after 5 years postoperatively, and the percentage of hyalinization gradually increased. Amylin deposits, detected by immunostaining, increased progressively in the islets in relation to the duration of postoperative period, correlating inversely with B-cell count and PCNA positivity. These histologic changes suggest that B cells proliferated secondary to oxyhyperglycemia in the early phase after gastrectomy followed by the state of waste, finally resulting in atrophy and amylin deposits, which led to hypofunction of the islets of Langerhans with resultant glucose intolerance. HUM PATHOL 31:1368-1376.

Amyloid↗
PubMedDate not supplied

1114 total gastrectomies in the surgical treatment of primary gastric adenocarcinoma--a 30-year single institution experience.

BACKGROUND/AIMS: Surgical therapy still represents the standard treatment for gastric carcinoma. Due to epidemiology and tumor stage, total gastrectomy is the most often required extent of gastric resection to obtain a potentially curative status. After a 30-year period we overviewed 1114 total gastrectomies, to our knowledge one of the biggest single-institution series in the Western Hemisphere. METHODOLOGY: Among 1991 cases with gastric carcinoma, treated between May 1968 and February 1998, 1114 patients underwent total gastrectomy. This prospectively documented series was retrospectively analyzed with special focus on various time periods. RESULTS: A constant increase of proximal gastric carcinomas was noted. R0-resections were feasible in 84.6% of total gastrectomies. Morbidity and mortality decreased to 22.2% and 5.5%, respectively, in the last decade. Overall 5-years survival rate was 32.4%. Survival was strongly influenced by tumor stage and R-classification. Overall and prognosis after R0-resection showed a significant time-dependent improvement. CONCLUSIONS: Total gastrectomy requires intensive surgical skills and can be performed with acceptable morbidity and low mortality. Survival after total gastrectomy can be improved with increasing experience, and the aim of total gastrectomy for gastric carcinoma should always focus on a R0-resection.

Adenocarcinoma↗
PubMedDate not supplied

Esophagogastrostomy reconstruction after limited proximal gastrectomy.

BACKGROUND/AIMS: Recent advances in diagnostic techniques have led to the detection of an increasing number of early gastric cancers in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for these cancers. METHODOLOGY: The clinicopathologic characteristics of 35 patients with early gastric cancer in the upper third of the stomach who underwent three different types of gastrectomies were reviewed retrospectively from hospital records between January 1992 and August 1999. RESULTS: Patients undergoing limited proximal gastrectomy with esophagogastrostomy reconstruction had shorter operation times and less blood loss than those for patients undergoing total gastrectomy or proximal gastrectomy with jejunal interposition. No lymph node metastasis was identified in any of these patients. Heartburn due to reflux esophagitis was seen in a few patients of each group, but they were successfully treated by antacids. The extreme reduction in food intake volume was more frequently experienced in patients with total gastrectomy than those with both proximal gastrectomies. When mortality due to other disease was excluded, all patients survived without recurrence. CONCLUSIONS: A limited proximal gastrectomy with esophagogastrostomy reconstruction decreased surgical risk and realized preservation of maximal function.

Esophagostomy↗
PubMedDate not supplied

Gastrectomy circumstances that influence early postoperative outcome.

BACKGROUND/AIMS: Despite decreasing mortality, gastric resection is still a procedure of significant morbidity. METHODOLOGY: Factors predicting post-gastrectomy outcome over 3 years in a tertiary care cancer center, single-surgeon experience were analyzed. RESULTS: Thirty-four patients who underwent total or partial gastrectomy at the City of Hope Cancer Center between 11/1996 and 11/1999 were analyzed. There were 21 males and 13 females, with a median age of 61 years (range: 36-97). Diagnoses included gastric malignancy (n = 28), hemorrhage from diffuse gastritis (n = 4), gastric necrosis with perforation (n = 1), and an aortogastric fistula (n = 1). The operative intent was curative in 22, and palliative in 6 cancer patients. Procedures included total (n = 14), subtotal (n = 9), distal (n = 8), and proximal gastrectomy (n = 3). Reconstruction techniques were Roux-Y (n = 25), BII (n = 5), primary esophagogastric anastomosis (n = 3), and primary gastric closure (n = 1). Twenty patients had prior abdominal operations (59%); 10 underwent resection of additional organs (29%), including 2 splenectomies. The median lymph node count was 24, and 20 cancer patients had a R0 resection (71%). Postoperative complications occurred in 14 patients (41%; major: 26%), with 3 in-hospital deaths and one 90-day fatality (90-day mortality: 12%). Predictors of complications were benign diagnosis (p = 0.01), emergency procedure (p = 0.01), and splenectomy (prior or concurrent) (p = 0.02). Cancer diagnosis (vs. benign) and nonemergent gastrectomy (vs. emergency) were each associated with lower mortality (4 vs. 50%, p = 0.01), median length of stay (12 vs. 19 d, p = 0.02), and tube feed duration (7 vs. 194 d, p = 0.04). Gastrectomies for cancer with curative intent (vs. palliative or therapeutic) had no mortality (p = 0.004), a major complication rate of 14% (p = 0.02), and a median stay of 12 days (p = n.s.). For patients with gastric cancer, pathologic stage was the only multivariate predictor of survival (p = 0.04) at a median follow-up of 9 months (15 for survivors); a median survival for patients with potentially curable disease (stage IA-IIIB) has not yet been reached. CONCLUSIONS: Gastrectomies for cancer, especially when done electively with curative intent, can lead to excellent postoperative recovery. Palliative gastrectomies or emergency procedures for "benign" conditions have significantly more complicated outcomes.

Adult↗
PubMed1992

[Stomach adenocarcinoma: what form of gastrectomy?].

Three hundred and sixty consecutive cases of gastric adenocarcinoma were studied retrospectively between 1976 and 1987. Surgery was curative in 195 patients: 91 had a subtotal gastrectomy 83 a total gastrectomy and 21 a proximal gastrectomy. Subtotal and total gastrectomy were compared within this group in terms of postoperative morbidity and mortality, abdominal comfort and 5-year actuarial survival: Postoperative mortality was greater after total gastrectomy (9.6 vs 2.2%, p = 0.04), as were anastomotic leaks (19 vs 2%, p = 0.0009). Mean weight loss was greater after total gastrectomy (p = 0.005). Comparison of patients with similar tumor staging and localization did not show any significant difference in 5-year actuarial survival. If subtotal gastrectomy is certainly justified for distal gastric cancer, it should be considered for some proximal localization.

Actuarial Analysis↗
PubMedDate not supplied

Duodenogastric reflux eradicates Helicobacter pylori after distal gastrectomy.

BACKGROUND/AIMS: Patients who undergo distal gastrectomy often develop duodenogastric reflux and preoperative H. pylori infection is eradicated spontaneously after distal gastrectomy in some patients. However, whether a causal relationship exists has not yet been studied. This report examines the correlation between H. pylori eradication and the amount of duodenogastric reflux following distal gastrectomy. METHODOLOGY: Among 72 consecutive patients who underwent curative distal gastrectomy with radical lymphadenectomy for gastric cancer, 37 patients had H. pylori infection preoperatively and were included in this study. The period of bile reflux (percent time) into the gastric remnant was measured with the Bilitec 2000 under standardized conditions on the 14th day after the surgery. Endoscopic examination was performed to determine the presence of H. pylori infection on week 12 after surgery. RESULTS: The percent time was higher in patients whose H. pylori infection had been eradicated after distal gastrectomy (58.1+/-9.2%) than in patients who had H. pylori infection after distal gastrectomy (33.8+/-5.7%). CONCLUSIONS: Duodenogastric reflux correlates with spontaneous eradication of H. pylori infection following distal gastrectomy.

Adult↗
PubMed2004

Effect of pouched reconstruction after total gastrectomy on ERCP and ENBD--report of two cases.

Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic nasobiliary drainage (ENBD) are well known to be useful but these procedures are rarely indicated in patients after total gastrectomy, because the endoscopic approach is more difficult in the patients with standard reconstructions such as Roux-en-y esophagojejunostomy after total gastrectomy. Gastric replacement with various enteric reservoirs after gastrectomy has been used to improve the postprandial symptoms and nutrition of patients after total gastrectomy. We have been performing jejunal pouch double tract reconstruction (JPD) after gastrectomy and the patients' postoperative course has been satisfactory. In this report, we describe two cases of biliary tract disorders after total gastrectomy. One was choledocholithiasis and the other was bile leakage after cholecystectomy. In each case, we performed ERCP, and treated with ENBD tube placement, and we obtained satisfactory results. We emphasize that ERCP and ENBD are also useful and easy procedures for biliary tract disease in postgastrectomy patients with JPD reconstruction as well as in patients who have not undergone intestinal reconstruction. The advantages of JPD reconstruction are not only improving the postprandial symptoms and the nutrition of patients after total gastrectomy, but that it provides an easy endoscopic approach to the papilla of Vater.

Aged↗