Tsuneki Tanaka

Gastroesophageal Reflux After Distal Gastrectomy: Possible Significance of the Angle of His

Objective:We investigated whether the angle of His influences gastroesophageal reflux after distal gastrectomy.Methods:Thirty-eight patients having distal gastrectomy and 10 controls underwent upper gastroesophageal fluoroscopy to measure the angle of His, and gastroesophageal reflux was assessed by scintigraphy. The association between scintigraphic reflux and the angle of His was then evaluated.Results:In distal gastrectomy patients with and without reflux symptoms, the angle was 108.82 ± in 21.88° and 96.07 ± 13.25°, respectively; it was 74.14 ± 10.85° in the controls. The angle was significantly larger in the patients than in the controls (p < 0.01). In addition, the angle in the symptomatic gastrectomy group tended to be larger than in the asymptomatic group. The angle was also significantly larger in patients with a scintigraphic reflux index ≥6% than in those with an index < 6% (p < 0.05).Conclusions:These findings suggest that the angle of His plays a role in reflux after distal gastrectomy and that the severity of reflux may be estimated by measuring this angle.

Evaluation of J-Pouch Reconstruction after Total Gastrectomy: ρ-Double Tract vs. J-Pouch Double Tract

Objective: Various enteric reservoirs have been advocated to improve the quality of life after total gastrectomy. We evaluated the advantages of pouch reconstruction compared with traditional ρ-double tract reconstruction. Design: Prospective randomized study. Setting: Second Department of Surgery, Hyogo College of Medicine, Japan. Subjects: Forty patients who underwent total gastrectomy for cancer of the stomach were studied. Intervention: Forty patients were randomly divided into two groups: 20 patients received ρ-double tract reconstruction (RDT group), and 20 underwent J-pouch double tract reconstruction (PDT group) group. Main Outcome Measures: We compared the body weight, serum nutritional parameters, reflux score, scintigraphic esophageal reflux, food intake, and emptying time of the J-pouch or ρ-limb between the two groups. Results: No difference was noted between the two groups with regard to body weight, but food intake tended to be higher in the PDT group than in the RDT group. Total protein and albumin levels were higher in the PDT group than in the RDT group, while scintigraphic reflux was significantly less prominent in the PDT group. Conclusions: J-pouch reconstruction was superior with respect to protein metabolism, food intake and reduction of reflux esophagitis compared with the traditional RDT method. However, use of pouch reconstruction did not improve postoperative weight gain.

Scintigraphic Assessment of Double Tract Reconstruction after Total Gastrectomy

Background/Aims: This study was carried out to evaluate the clinical significance of double tract reconstruction after total gastrectomy. Methods: 25 patients, 14 with jejunal pouch double tract reconstructions and 11 with ρ-double tract reconstructions, were studied. Scintigraphy was used to evaluate duodenal and jejunal passage, and the jejunal/duodenal ratio was calculated. The patients were classified into 3 groups based on this ratio: group A (n = 14) ratio <1; group B (n = 6) ratio 1–2, and group C (n = 5) ratio >2. The reflux score, scintigraphic reflux index, emptying time of the jejunal pouch or ρ-limb, and various nutritional parameters were compared between the 3 groups. Results: The emptying time was shortest in group B, but there was no significant difference among the 3 groups in the Sigstad dumping scores. The reflux score, scintigraphic reflux index, and most nutritional parameters also showed no significant differences between the 3 groups. Leakage at the duodenojejunostomy did not occur in any patient. Conclusion: Our findings suggest that there was no preferential passage via the duodenum or jejunum after double tract reconstruction. This method is also useful for decompression of the duodenal stump and group B seemed to have the ideal reconstruction on the basis of emptying time.