Risk Factors for Food Residue after Distal Gastrectomy and a New Effective Preparation for Endoscopy: The Water-Intake Method

Abstract

Background/AimsFood residue is frequently observed in the gastric remnant after distal gastrectomy, despite adequate preparation. We devised a water-intake method to reduce food residue in the gastric remnant by drinking large quantities of water in a short time. The aims of this study were to identify the risk factors for food residue and to study the effectiveness of this new method for endoscopy preparation.MethodsA cohort of 708 patients who underwent distal gastrectomy for gastric cancer was reviewed prospectively. Sixty patients with large amounts of food residue were randomly divided into two groups: a water-intake group (n=40) and a prolonged fasting group (n=20).ResultsThe incidences of a large amount of food residue were 15.7%, 5.8%, 7.5%, and 2.8% at 3, 12, 24, and 36 months, respectively, after distal gastrectomy. Independent risk factors for food residue were endoscopy at 3 months, diabetes mellitus, a body mass index of <19.5, and laparoscopic surgery. The proportion of successful preparations at follow-up endoscopy was higher for the water-intake group (70%) than for the prolonged fasting group (40%, p=0.025).ConclusionsThe water-intake method can be recommended as a preparation for endoscopy in patients who have had repetitive food residue or risk factors after distal gastrectomy.

Incidence of food residue interfering with postoperative endoscopic examination for gastric pull-up after esophagectomy

“…Unfortunately, we failed to determine the risk factors for the food residue. To decrease the incidence, fasting more than 18 h before the examination [11], drinking water on the evening before and on the day of the endoscopy [10,17], and ingesting only a liquid or soft diet on the day before the examination [11] have been recommended for gastrectomized patients to reduce the food residue in their gastric remnant. These preparation methods can also be applied for esophagectomized patients to minimize the presence of food residue from their gastric pull-ups.…”

“…The second reason is that the present study only evaluated the first endoscopic images, even if the patient had undergone multiple endoscopies at our center. Repeated examinations probably reduce the food residue from the gastric pull-up because the patients try to prepare more carefully than in their previous failed examinations [10,11].…”

“…The presence of food residue can obscure the tract surface, resulting in overlooked lesions or a requirement of reexamination [10,11]. In spite of appropriate preparation, food residue that interferes with the examination is occasionally observed in an operated stomach because of its gastro-pyloric hypomotility [12].…”

“…Conclusion The food residue interfering with postoperative endoscopic examination was observed in 17.2 % of all surveyed gastric pull-ups. residue and its risk factors in the gastric remnant after partial gastrectomy has been studied by endoscopic evaluation [10,11,13,14], there have been few studies of this kind on the gastric pull-up after esophagectomy. The aims of the present study were to elucidate the incidence and potential risk factors associated with food residue in gastric pull-up after esophagectomy.…”

Efficacy of a New Preparation Regimen with Mosapride and Low Volume of Water Intake for Endoscopy Preparation in Post gastrectomy Patients

“…However, to date, there is limited data regarding the effects of different preparation regimens for endoscopy in postgastrectomy patients. One recent study showed that the intake of a large quantity of water (1L) in a short time was effective and convenient for endoscopy preparation in patients who presented food residue [6] . However, ingesting a large volume of water is not well tolerated by the patients.…”