Long-Term Follow-up of Patients with Jejunal Pouch Reconstruction after Total Gastrectomy: A Randomized Prospective Study

Abstract

Iivonen MK, Mattila JJ, Nordback IH, Matikainen MJ. Long-term follow-up of patients with jejunal pouch reconstruction after total gastrectomy. A randomized prospective study. Scand J Gastroenterol 2000;35:679-685. Background: Fifty-one patients were operated on during 1988-1992 and randomized after total gastrectomy to one of two reconstruction types. Twenty patients with jejunal pouch reconstruction and 14 patients with Roux-en-Y reconstruction (67% of all) survived at least 3 years after total gastrectomy. We studied symptoms, eating capacity, and nutrition in these patients during the clinical follow-up; 21 patients were assessed by mail questionnaire 8 years after total gastrectomy. Methods: Postoperative symptoms, number of meals, and eating capacity were assessed by standard questionnaire during 3 years' follow-up. Weight loss and nutritional laboratory variables were measured, and upper intestinal endoscopy with biopsy was performed during the follow-up. Eight years after the operation symptoms, ability to eat, and number of meals consumed were studied by means of a mail questionnaire. Results: Three years postoperatively dumping (64% compared with 10%, P`0.05) and early satiety (86% compared with 5%, P`0.05) were commoner in the Roux-en-Y group. In the pouch group eating capacity was better (96% of normal compared with 67%, P`0.05), and the patients ate fewer meals per day (mean, 2.7 versus 5.3, P`0.05) at 3 years. Mean weight loss at 3 years was 9.9 kg in the Roux-en-Y group compared with 1.5 kg in the pouch group (P`0.05). 25 (OH) vitamin D concentration tended to be higher in the pouch group (47.3 nmol/l compared with 33.9 nmol/l). In the Roux-en-Y group serum alkaline phosphatase activity increased significantly during the 3 postoperative years (from mean163 U/l to 248 U/l, P`0.01) and tended to be higher (248 U/l compared with 216 U/l in the pouch group). None of the patients developed oesophagitis or pouchitis during the follow-up. One patient developed a bezoar in the pouch 5 years after gastrectomy. Conclusions: Pouch reconstruction after total gastrectomy is associated with diminished postoperative symptoms, better eating capacity, and decreased weight loss compared with Roux-en-Y reconstruction. Jejunal pouch reconstruction is thus the recommended surgical method after total gastrectomy.

Results of Reconstruction with Jejunal Pouch after Gastrectomy: Correlation with Gastrointestinal Motor Activity

“…Bozzetti et al [28] reported that there were no differences in BW and eating habits between these 2 groups but that after JPRY-T, there were less gastrointestinal symptoms; although they concluded that there was no substantive benefit of pouch reconstruction, we classified their results as ‘positive’ according to our definition. The remaining 4 studies showed a benefit with JPRY-T in terms of eating capacity, food intake, BW, nutrition and symptoms [29,30,31,32]. When considered together, these 9 studies suggest that the postoperative results of JPRY-T are generally more favorable than those of RY-T.…”

Recovery of Food Intake after Gastrectomy for Gastric Cancer: Based on a Large-Scale Gastric Cancer Cohort

“…Nomura et al [6] observed better nutritional outcomes, including food intake and body weight, in the distal 2/3 gastrectomy group compared with the 4/5 gastrectomy or TG. Additionally, it was reported that patients with a gastric reservoir, such as pouch reconstruction after TG, had improved food intake compared to those without a gastric reservoir [5,7,8].…”

“…Various mechanisms may be involved, including reduced food intake due to early satiety and loss of appetite, rapid transit with diarrhea, and alteration of endocrine hormones, such as ghrelin and cholecystokinin [4,5,[7][8][9][10][11]. Among these factors, reduced food intake is frequently suggested as an important factor related to weight loss, and many surgeons have attempted to identify the best method of resection or reconstruction for conserving food intake [5,6,[12][13][14].…”

Quality of Life in Patients with Oesophageal and Gastric Cancer: An Overview

“…Pouch reconstruction allows a larger meal size, which frequently reaches preoperative level [79, 85]. However, meal size increases with follow-up, irrespective of the type of reconstruction, and differences between pouch reconstruction and simple oesophagojejunostomy become small after prolonged follow-up [75].…”