Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy

Tsunehiro Takahashi, Masashi Yoshida, Tetsuro Kubota, Yoshihide Otani, Yoshiro Saikawa, Hideki Ishikawa, Kazuhiro Suganuma, Yukako Akatsu, Koichiro Kumai, Masaki Kitajima

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15 Citations (Scopus)

Abstract

The precise mechanisms that cause gastroesophageal reflux after distal gastrectomy remain unclear. We analyzed the endoscopic findings of the cardia and the position of the remnant stomach, which are related to gastroesophageal reflux. We retrospectively examined the records of 45 patients with Billroth I (B-I) and 39 patients with Roux-en-Y (R-Y) procedure for gastric cancer. Esophagitis was evaluated by the Los Angeles (LA) classification. The endoscopic findings of hiatus hernia were classified according to the criteria of the Keio Cancer Detection Center form (K-form). The valvular appearance of the cardia was classified according to V-grades. The height of the remnant stomach was measured on computed tomography scans. The postoperative findings of esophagitis in the B-I group were significantly worse than the preoperative findings, but no significant change was observed in the R-Y group. The postoperative V-grades and K-forrn findings in the B-I group were worse than their preoperative findings. In the R-Y group, however, there was no significant change in the V-grades or K-form findings. In addition, the height of the remnant stomach was significantly higher in the B-I group than in the R-Y group. This study suggested that an aggravated cardia is associated with the B-I procedure and that the position of the remnant stomach may therefore play an important role in the occurrence of postoperative reflux esophagitis. In contrast, the R-Y operation was shown to preserve the cardia and the position of the remnant stomach better. As a result, R-Y might help prevent not only duodenogastric reflux but also gastroesophageal reflux.

Original languageEnglish
Pages (from-to)50-57
Number of pages8
JournalWorld Journal of Surgery
Volume29
Issue number1
DOIs
Publication statusPublished - 2005 Jan 1

ASJC Scopus subject areas

  • Surgery

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    Takahashi, T., Yoshida, M., Kubota, T., Otani, Y., Saikawa, Y., Ishikawa, H., Suganuma, K., Akatsu, Y., Kumai, K., & Kitajima, M. (2005). Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy. World Journal of Surgery, 29(1), 50-57. https://doi.org/10.1007/s00268-004-7415-3