Top

Published in:

01-12-2007

Roux-en-Y Reconstruction after Distal Gastrectomy to Reduce Enterogastric Reflux and Helicobacter pylori Infection

Authors: De-Chuan Chan, Yu-Ming Fan, Chih-Kung Lin, Cheng-Jueng Chen, Ching-Yuan Chen, You-Chen Chao

Published in: Journal of Gastrointestinal Surgery | Issue 12/2007

Abstract

Enterogastric reflux (EGR) is regarded as an unavoidable consequence of distal gastrectomy. We evaluated the efficacy of Roux-en-Y (RY) gastrojejunostomy and Braun enteroenterostomy (BEE) for preventing EGR. Between January 2002 and January 2005, 60 patients who underwent distal gastrectomy for gastric cancer or peptic ulcers were divided into RY, Billroth II reconstruction (BII) without or with BEE (BII+B) according to reconstructive method. After 12 months, EGR and mucosal alterations of the remnant stomach were evaluated using biliary scintigraphy, endoscopy, and histology. Scintigraphy showed fasting and postprandial EGR into the remnant stomach occurred in 5.3% and 21.1% of the RY group, 62.1% and 93.1% of the BII group, and 50.0% and 91.7% of the BII+B group, respectively. Endoscopy showed bile reflux occurred in 15.8% of the RY group, 75.9% of the BII group, and 83.3% of the BII+B group. In addition, the prevalence of Helicobacter pylori (HP) infection in the RY group was less than in the other groups (P < 0.02). Therefore, RY after distal gastrectomy was effective in reducing EGR and HP infection. BEE was ineffective in diverting bile flow away from the gastric remnant.

Yoshino K. History of gastric cancer surgery. J Jpn Surg Soc 2000;101:855–860.

Fiore AC, Malangoni MA, Broadie TA, Madura JA, Jesseph JE. Surgical management of alkaline reflux gastritis. Arch Surg 1982;117:689–694.PubMed

Northfield TC, Hall CN. Carcinoma of the gastric stump: Risks and pathogenesis. Gut 1990;31:1217–1219.PubMedCrossRef

Buhl K, Lehnert T, Schlag P, Herfarth C. Reconstruction after gastrectomy and quality of life. World J Surg 1995;19:558–564.PubMedCrossRef

Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy: Prevention and treatment of alkaline reflux gastritis. An alternative to Roux-en-Y Diversion. Ann Surg 1994;219:458–466.PubMedCrossRef

Fisher RS, Malmud LS, Roberts GS, Lobis IF. Gastroesophageal (GE) scintiscanning to detect and quantitate GE reflux. Gastroenterology 1976;70(3):301–308.PubMed

Niemela S. Duodenograstric reflux in patients with upper abdominal complaints or gastric ulcer with particular reference to reflux-associated gastritis. Scand J Gastroenterol 1985;20:1–56.

Dixon MF, O’Connor HJ, Axon ATR, King RFJG, Johnston D. Reflux gastritis: distinct histopathological entity? J Clin Pathol 1986;39:524–530.PubMedCrossRef

Furukawa H, Iwanaga T, Hiratsuka M, Imaoka S, Ishikawa O, Kabuto T, et al. Gastric remnant cancer as a metachronous multiple lesion. Br J Surg 1993;80:54–56.PubMedCrossRef

10.

Obradovic VB, Artiko V, Chebib HY, et al. Estimation of the enterogastric reflux by modified scintigraphic method. Gastroenterology 2000;47:738–741.

11.

Mackie CR, Hulks G, Cuschieri A. Enterogastric reflux and gastric clearance of refluxate in normal subjects and in patients with and without bile vomiting following peptic ulcer surgery. Ann Surg 1986;204:537–542.PubMedCrossRef

12.

Karlqvist P, Norrby K, Svedberg J, Sjodahl R. Enterogastric reflux after gastric surgery: A comparison between gastroduodenostomy and Roux diversion. Scand J Gastroenterol 1985;20:861–867.PubMed

13.

Lindecken KD, Salm B. The effectiveness of Braun’s anastomosis in Billroth II surgery. The role of hepatobiliary sequence scintigraphy (HBSS) in the diagnosis of bile flow following stomach resection. Rofo 1993;159(2):158–160.PubMed

14.

Shinoto K, Ochiai T, Suzuki T, Okazumi S, Ozaki M. Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today 2003;33(3):169–177.PubMedCrossRef

15.

Mackie CR, Wisbey ML, Cuschieri A. Milk 99Tcm-EHIDA test for enterogastric bile reflux. Br J Surg 1982;69(2):101–104.PubMedCrossRef

16.

Tolin RD, Malmud LS, Stelzer F, Menin R, Makler PT Jr, Applegate G, Fisher RS. Enterogastric reflux in normal subjects and patients with Bilroth II gastroenterostomy. Measurement of enterogastric reflux. Gastroenterology 1979;77(5):1027–1033.PubMed

17.

Uemura N. The magnitude of association between Helicobacter pylori infection and the development of gastric cancer. Scand J Gastroenterol 2002;37:869–870.PubMedCrossRef

18.

Uemura N, Mukai T, Okamoto S. Helicobacter pylori infection and the background gastric mucosa in the patients with gastric cancer. Rinsho Geka 1997;52:161–168.

19.

Enomoto H, Watanabe H, Nishikura K, Umezawa H, Asakura H. Topographic distribution of Helicobacter pylori in the resected stomach. Eur J Gastroenterol Hepatol 1998;10:473–478.PubMedCrossRef

20.

O’Connor HJ, Dixon MF, Wyatt JI, Axon AT, Ward DC, Dewar EP, et al. Effect of duodenal ulcer surgery and enterogastric reflux on Campylobacter pyloridis. Lancet 1986;ii:1178–1181.CrossRef

21.

Robles-Campos R, Lujan-Mompean JA, Parrilla-Paricio P, Bermejo-Lopez J, Liron-Ruiz R, Torralba-Martinez JA, et al. Role of Helicobacter pylori infection and duodenogastric reflux in the pathogenesis of alkaline reflux gastritis after gastric operations. Surg Gynecol Obstet 1993;176:594–598.PubMed

22.

Nagahata Y, Kawakita N, Azumi Y, Numata N, Yano M, Saitoh Y. Etiological involvement of Helicobacter pylori in ‘reflux’ gastritis after gastrectomy. Am J Gastroenterol 1996;91:2130–2134.PubMed

23.

Leivonen M, Haglund C, Nordling S. Helicobacter pylori infection after partial gastrectomy for peptic ulcer and its role in relapsing disease. Eur J Gastroenterol Hepatol 1997;9:371–374.PubMed

24.

Kuipers EJ, Thijs JC, Festen PM. The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther 1995;9(suppl 2):59–69.PubMed

25.

Offerhaus GJA, Rieu PNMA, Jansen JBMJ, Joosten HJM, Lamers CBHW. Postoperative comparative study of the influence of postoperative bile reflux on gastric mucosal histology and Campylobacter pylori infection. Gut 1989;30:1552–1527.CrossRef

26.

Nakagawara H, Miwa K, Nakamura S, Hattori T. Duodenogastric reflux sustains Helicobacter pylori infection in the gastric stump. Scand J Gastroenterol 2003;38(9):931–937.PubMedCrossRef

27.

Bechi P, Amorosi A, Mazzanti R, Romaqnoli P, Tonelli L. Gastric histology and fasting bile reflux after partial gastrectomy. Gastroenterology 1987;93(2):335–343.PubMed

28.

Niemela S, Karttunen T, Heikki la J, Lehtola J. Characteristics of reflux gastritis. Scand J Gastroenterol 1987;22(3):349–354.PubMed

29.

Houghton PWJ, Mortensen NJMcC, Thomas WEG, Cooper MJ, Morgan AP, Burton P. Intragastric bile acids and histological changes in gastric mucosa. Br J Surg 1986;74:354–356.CrossRef

30.

Ishii T. Experimental study on the atrophic gastritis especially on the cause of the postoperative gastritis and on the histogenesis of experimentally induced atrophic gastritis. Jpn Gastroenterol 1966;63:1323–1337.

31.

Smith GM. An experimental study of the relation of bile to ulceration of the mucous membrane of the stomach. J Med Res 1914;30:147–184.

32.

Mukawa K, Nakamura T, Nakano G, Nagamachi Y. Histopathogenesis of intestinal metaplasia: minute lesions of intestinal metaplasia in ulcerated stomachs. Clin Pathol 1987;40:13–18.CrossRef

33.

Silva S, Filipe MI, Pinho A. Variants of intestinal metaplasia in the evolution of chronic atrophic gastritis and gastric ulcer. A follow-up study. Gut 1990;31:1097–1104.PubMedCrossRef

34.

Leivonen M, Nordling S, Haglund C. Does Helicobacter pylori in the gastric stump increase the cancer risk after certain reconstruction types? Anticancer Res 1997;17:3893–3896.PubMed

35.

Lynch DAF, Mapstone NP, Clarke AMT, et al. Cell proliferation in the gastric corpus in Helicobacter pylori associated gastritis and after gastric resection. Gut 1995;36:351–353.PubMedCrossRef

36.

Abe H, Murakami K, Satoh S, Sato R, Kodama M, Arita1 T, Fujioka T. Influence of bile reflux and Helicobacter pylori infection on gastritis in the remnant gastric mucosa after distal gastrectomy. J Gastroenterol 2005;40:563–569.PubMedCrossRef

37.

Sobala GM, O’Connor HJ, Dewar EP, King RF, Axon AT, Dixon MF. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol 1993;46:235–240.PubMedCrossRef

Title: Roux-en-Y Reconstruction after Distal Gastrectomy to Reduce Enterogastric Reflux and Helicobacter pylori Infection
Authors: De-Chuan Chan
Yu-Ming Fan
Chih-Kung Lin
Cheng-Jueng Chen
Ching-Yuan Chen
You-Chen Chao
Publication date: 01-12-2007
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 12/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-007-0302-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Roux-en-Y Reconstruction after Distal Gastrectomy to Reduce Enterogastric Reflux and Helicobacter pylori Infection

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2007

Surgical Management of Gastro–Gastric Fistula After Divided Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

Metastatic Melanoma Causing Jejunal Intussusception

Stapled Hemorrhoidopexy: A Prospective Study From Pathology to Clinical Outcome

Preservation of the Anal Transition Zone in Ulcerative Colitis. Long-Term Effects on Defecatory Function

Acute Pancreatitis and Pregnancy: A 10-Year Single Center Experience

Curative Laparoscopic Resection for Pancreatic Neoplasms: A Critical Analysis from a Single Institution