Journal of Gastrointestinal Surgery

, Volume 15, Issue 5, pp 824–828

Reflux Esophagitis and Marginal Ulcer After Pancreaticoduodenectomy

Authors

  • Jin-Ming Wu
    • Department of Surgery, National Taiwan University HospitalNational Taiwan University College of Medicine
  • Meng-Kun Tsai
    • Department of Surgery, National Taiwan University HospitalNational Taiwan University College of Medicine
  • Rey-Heng Hu
    • Department of Surgery, National Taiwan University HospitalNational Taiwan University College of Medicine
  • Kin-Jen Chang
    • Department of Surgery, National Taiwan University HospitalNational Taiwan University College of Medicine
  • Po-Huang Lee
    • Department of Surgery, National Taiwan University HospitalNational Taiwan University College of Medicine
    • Department of Surgery, National Taiwan University HospitalNational Taiwan University College of Medicine
Original Article

DOI: 10.1007/s11605-011-1463-4

Cite this article as:
Wu, J., Tsai, M., Hu, R. et al. J Gastrointest Surg (2011) 15: 824. doi:10.1007/s11605-011-1463-4

Abstract

Background

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.

Methods

We retrospectively studied both reflux esophagitis and marginal ulcer after 371 PDs and analyzed the association with different methods of gastrointestinal reconstruction.

Results

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).

Conclusions

Our data support the use of Roux-en-Y reconstruction after standard PD but not after PPPD.

Keywords

PancreaticoduodenectomyAnastomosisRoux-en-YMarginal ulcerReflux esophagitis

Copyright information

© The Society for Surgery of the Alimentary Tract 2011