Reflux Esophagitis and Marginal Ulcer After Pancreaticoduodenectomy
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- Wu, JM., Tsai, MK., Hu, RH. et al. J Gastrointest Surg (2011) 15: 824. doi:10.1007/s11605-011-1463-4
Reflux esophagitis is a common complication following a distal gastrectomy. Increasingly, Roux-en-Y reconstruction has been used to prevent reflux esophagitis; however, marginal ulcer is a concern in patients with a Roux-en-Y reconstruction after distal gastrectomy. The effect of Roux-en-Y reconstruction on the development of reflux esophagitis and marginal ulcer after pancreaticoduodenectomy (PD) has not been studied.
We retrospectively studied both reflux esophagitis and marginal ulcer after 371 PDs and analyzed the association with different methods of gastrointestinal reconstruction.
In a median follow-up time of 20 months, 40 (10.8%) of the 371 patients developed reflux esophagitis, 15 after 158 standard PD, and 25 after 213 pylorus-preserving pancreaticoduodenectomy (PPPD; P = 0.62). Cox regression model showed Roux-en-Y reconstruction was significantly inversely related to occurrence of reflux esophagitis in 158 patients after standard PD (P = 0.04) but not in 213 patients after PPPD (P = 0.24). Thirty-five of 371 studied patients developed marginal ulcer, 15 after standard PD and 20 after PPPD (P = 0.45). Multivariate analysis showed that Roux-en-Y reconstruction was the only significant predictor for marginal ulcer after PD (P = 0.02).
Our data support the use of Roux-en-Y reconstruction after standard PD but not after PPPD.