A Case of Severe Reflux Esophagitis After Total Gastrectomy Reconstruction in Billroth^|^ndash;II Resolved by a Simple Reoperation

Taniguchi, Kiyoaki; Sasagawa, Tsuyoshi; Takeichi, Satoshi; Yamada, Takuji; Suzuki, Hiroko; Kitamura, Yoichi; Yamamoto, Masakazu

doi:10.4030/jjcs.36.937

Cited by 2 publications

(3 citation statements)

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“…The first is a reconstructive method. The Billroth II method, in which the duodenal fluid passes through the anastomosis, has been reported to cause esophagitis in 50–60% of cases, whereas the RY method has been reported to have an incidence of 10–30% [ 18 ]. Next, the shorter the anastomotic distance, the more likely reflux esophagitis occurs, and the frequency decreases when the anastomotic distance is > 40 cm [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases

et al. 2021

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Background Reflux esophagitis after total gastrectomy is often difficult to treat. In this report, we describe two cases of reflux esophagitis that were refractory to medical therapy and successfully treated by transposition of the jejunojejunal anastomosis. Case presentation Case 1: A 66-year-old man underwent total gastrectomy and cholecystectomy for gastric cancer, and Roux-en-Y (RY) reconstruction was performed. The pathological diagnosis was T4aN3aM0 stage IIIC. Five months later, esophagogastroduodenoscopy identified reflux esophagitis. Although he was treated with various oral medications and was hospitalized six times, he lost 19 kg of weight. Finally, the patient was reoperated 3 years postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions that could have caused obstruction, and the anastomotic distance between the esophagojejunostomy and the jejunojejunostomy was approximately 40 cm. The jejunojejunostomy was re-anastomosed to increase the distance to 100 cm. Two years and 6 months after the reoperation, there was no recurrence of reflux esophagitis, and the patient’s weight increased by 14 kg. Case 2: A 68-year-old woman underwent total gastrectomy and cholecystectomy for gastric cancer, and RY reconstruction was performed. The pathological diagnosis was T4aN0M0 stage IIB. Similar to Case 1, the patient was diagnosed with reflux esophagitis 5 months later. She lost 23 kg of weight and was reoperated at 6 months postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions, and transposition of the jejunojejunostomy was performed to increase the distance between anastomoses from 40 to 100 cm. Two years and 8 months after the reoperation, there was no recurrence of reflux esophagitis, and her weight increased by 15 kg. Conclusions Transposition of the jejunojejunostomy was an effective treatment for medication-resistant severe reflux esophagitis after total gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases

et al. 2021

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“…This method has a described incidence of ARO of 50%-60% of cases. 4 Comparatively, the RY method has a described incidence of 10%-30%. 4 Roux-en-Y esophagojejunostomy is widely accepted as the preferred reconstructive procedure and is effective in preventing reflux, maintaining ideal patient weight.…”

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confidence: 99%

“…4 Comparatively, the RY method has a described incidence of 10%-30%. 4 Roux-en-Y esophagojejunostomy is widely accepted as the preferred reconstructive procedure and is effective in preventing reflux, maintaining ideal patient weight. 3 Second, the shorter the anastomotic distance, the more likely ARO to occur, and it has been demonstrated with an anastomotic distance of > 40 cm that leads to less ARO.…”

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Management Experiences of Post-Gastrectomy Severe Alkaline Reflux Esophagitis

Temperley

Phoenix

Waters

et al. 2023

The American Surgeon™

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Alkaline reflux esophagitis is a recognized complication of procedures that compromise the lower esophageal sphincter (LES), including gastrectomy. Incidence of reflux is dependent on the reconstructive procedure, with Roux-en-Y (RY) esophagojejunostomy commonly accepted as the optimal method. The authors report their experience of 5 patients who underwent remedial intervention for severe alkaline reflux esophagitis following gastric cancer surgery, over a 6-year period (2014-2020). Primary diagnoses encompassed 4 gastric adenocarcinomas and 1 gastric neuroendocrine tumor. Four patients previously underwent total gastrectomy and 1 subtotal gastrectomy with RY reconstruction. Onset of postoperative reflux symptoms ranged from 2 weeks to 3 years. Failing medical management, all patients underwent jejunojejunal anastomosis and Roux limb length revision with surgical jejunostomy. At follow-up, 4 out of 5 patients had some degree of symptom resolution and one with unresolved symptoms. The authors report our experience of managing this complication following gastrectomy with jejunojejunal anastomosis and Roux limb length revision.

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A Case of Severe Reflux Esophagitis After Total Gastrectomy Reconstruction in Billroth^|^ndash;II Resolved by a Simple Reoperation

Cited by 2 publications

References 1 publication

Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases

Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases

Management Experiences of Post-Gastrectomy Severe Alkaline Reflux Esophagitis

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