Morphologic Analysis of Gastroesophageal Reflux Diseases in Patients after Distal Gastrectomy

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.

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction

“…17,18 However, the most common disadvantage of the B-I anastomosis, duodenogastric reflux caused of remnant gastritis and reflux esophagitis, as the absence of the pyloric sphincter which allows reflux of duodenal contents into the remnant stomach is well reported. 19,20 In addition, rapid passage of semiliquid food into the duodenum from the stomach results in dumping syndrome. Moreover, it is necessary to note that duodenal reflux into the esophagus is strongly associated with Barrett's esophagus or esophageal cancer and remnant stomach cancer after gastrectomy.…”

Reflux Esophagitis and Marginal Ulcer After Pancreaticoduodenectomy

“…[33][34][35] Untreated reflux esophagitis has been reported to have a greater effect on quality of life than do other conditions including angina pectoris, untreated hypertension, and duodenal ulcer. 36,37 This may account for the increasing use of Roux-en-Y reconstruction after a distal gastrectomy for gastric cancer. 18 In conclusion, our study showed that R-Y reconstruction was associated with significantly less reflux esophagitis after standard PD (but not after PPPD) and was associated with a significantly greater incidence of marginal ulcer after both standard PD and PPPD.…”

Endoscopic classifications as diagnostic factors of peptic ulcer and early gastric cancer – a possible reason why Helicobacter pylori infection causes gastric ulcers along lesser curvature

“…Grade D is a circumferential mucosal break. Endoscopic findings in hiatus hernia were classified according to the K‐form criteria 9,10 . In grade 0, the mucosal junction is below the hiatus.…”

“…Endoscopic findings in hiatus hernia were classified according to the K-form criteria. 9,10 In grade 0, the mucosal junction is below the hiatus. Grade A is a definite hiatus hernia, and a sac-shaped portion covered with gastric mucosa is seen more than 3 cm above the hiatus.…”

“…If some relationship between these factors and the type of early gastric cancer exist, it can be an important knowledge for endoscopists to avoid missing the small early gastric cancers, because the findings of gastric cancer differ according to the histological typing 8 . The K‐form criteria 9–11 is a classification of hiatus hernia, particularly by the assessment of minor hernia. The V‐grade, first described by Ismail et al , 12 is a classification of the valvular appearance of the cardia as visualized from below using a retroflexed endoscope.…”