Endoscopic evaluation of reconstruction after proximal gastrectomy for cancer: Gastric tube versus jejunal interposition

Abstract

Background: Since 1997, we have introduced proximal gastrectomy and gastric tube reconstruction for patients with small or superficial cancer of the gastric cardia. The aim of the present study was to present our experience with proximal gastrectomy in these patients and to assess the usefulness of this technique. Methods: We studied 12 patients who underwent proximal gastrectomy for cancer of the gastric cardia at the Koga Hospital. The mode of anastomosis was gastric tube reconstruction (n = 8) or jejunal interposition (n = 4). Clinical and endoscopic findings were evaluated with special reference to the reflux esophagitis. Results: Operation time for gastric tube reconstruction was significantly shorter than that for jejunal interposition (234 vs 359 min, respectively; P < 0.01). Although one patient with jejunal interposition experienced dysphagia and vomiting, no patient with gastric tube reconstruction had such symptoms. Endoscopy showed that one symptomatic patient with jejunal interposition and one asymptomatic patient with gastric tube reconstruction had esophagitis. The remaining patients were free from esophagitis on endoscopy and all patients were alive without recurrence. Conclusion: In patients with proximal gastrectomy, surgical and endoscopic results were satisfactory after gastric tube reconstruction. Because the procedure is simple and safe, this technique is the treatment of choice for early proximal gastric cancer.