Abstract
Background
Small-bowel capsule endoscopy (SBCE) has become an increasingly utilized imaging modality for patients suspected of having small intestinal diseases. However, data regarding the role of SBCE in patients with Billroth II gastrojejunostomy are limited. The objective is to evaluate the safety and efficacy of SBCE in Billroth II gastrojejunostomy patients.
Methods
We retrospectively studied patients with Billroth II gastrojejunostomy who underwent MiroCam capsule endoscopy between August 2013 and October 2019. Baseline patient characteristics; gastroscopic and SBCE findings; capsule transit time; and the occurrence of adverse events were collected and compared between groups with and without anastomotic lesions.
Results
In total, 30 patients were analyzed in the study. The median age was 59 years, and 26 patients (86.7%) were men. The majority of SBCE positive findings including ulcers (10.0%), angioectasias (6.7%) and polyps (6.7%). In patients with (n = 10) and without (n = 20) anastomotic lesions, the anastomotic lesion was significantly associated with a delayed gastric transit time (GTT) (P = 0.026), but the two groups showed no significant difference in completion (P > 0.05). All patients underwent successful SBCE examinations without adverse events, except device transit into the afferent loop, where it remained for nearly 2 h, occurred in one case with anastomotic ulcers.
Conclusions
This retrospective study demonstrates that SBCE is a safe and effective diagnostic tool in patients with Billroth II gastrojejunostomy with a favorable gastroscopic evaluation within 7 days prior. The frequently real-time monitoring is suggested due to the risk of retention in the afferent loop, and a delayed food intake is required when a prolonged stay in the afferent loop occurred.
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References
Gerson LB, Fidler JL, Cave DR, Leighton JA (2015) ACG Clinical Guideline Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol 110:1265–1287
Liao Z, Gao R, Xu C, Li ZS (2010) Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 71:280–286
Varela Lema L, Ruano-Ravina A (2008) Effectiveness and safety of capsule endoscopy in the diagnosis of small bowel diseases. J Clin Gastroenterol 42:466–471
Pedrazzani C, Marrelli D, Rampone B, De Stefano A, Corso G, Fotia G, Pinto E, Roviello F (2007) Postoperative complications and functional results after subtotal gastrectomy with Billroth II reconstruction for primary gastric cancer. Dig Dis Sci 52:1757–1763
He L, Zhao Y (2019) Is Roux-en-Y or Billroth-II reconstruction the preferred choice for gastric cancer patients undergoing distal gastrectomy when Billroth I reconstruction is not applicable? A meta-analysis Medicine (Baltimore) 98:e17093
Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W (2019) Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 25:3313–3333
Tanisaka Y, Ryozawa S, Mizuide M, Harada M, Fujita A, Ogawa T, Nonaka K, Tashima T, Araki R (2019) Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope for patients with surgically altered gastrointestinal anatomy. Dig Endosc 31:682–689
Li JS, Zou DW, Jin ZD, Shi XG, Chen J, Li ZS, Liu F (2020) Predictive factors for extraction of common bile duct stones during endoscopic retrograde cholangiopancreatography in Billroth II anatomy patients. Surg Endosc 34:2454–2459
Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, Leontiadis GI, Tse F, Sadowski D (2017) Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology 152:497–514
Ling CR, Wang MJ, Zhuang W (2017) Capsule retention for 7.5 years in Meckel’s diverticulum. Dig Endosc 29:386–387
Tanaka Y, Motomura Y, Akahoshi K, Nakama N, Osoegawa T, Kashiwabara Y, Chaen T, Higuchi N, Kubokawa M, Nishida K, Yukaya T, Oya M, Nakamura K (2010) Capsule endoscopic detection of bleeding Meckel’s diverticulum, with capsule retention in the diverticulum. Endoscopy 42(Suppl 2):E199-200
Lin L, Liu K, Liu H, Wu J, Zhang Y (2019) Capsule endoscopy as a diagnostic test for Meckel’s diverticulum. Scand J Gastroenterol 54:122–127
Le Blanc-Louvry I, Ducrotté P, Peillon C, Testart J, Denis P, Michot F, Tenière P (1999) Upper jejunal motility after pancreatoduodenectomy according to the type of anastomosis, pancreaticojejunal or pancreaticogastric. J Am Coll Surg 188:261–270
Barth BA, Donovan K, Fox VL (2004) Endoscopic placement of the capsule endoscope in children. Gastrointest Endosc 60:818–821
Gao YJ, Ge ZZ, Chen HY, Li XB, Dai J, Ye CA, Xiao SD (2010) Endoscopic capsule placement improves the completion rate of small-bowel capsule endoscopy and increases diagnostic yield. Gastrointest Endosc 72:103–108
Holden JP, Dureja P, Pfau PR, Schwartz DC, Reichelderfer M, Judd RH, Danko I, Iyer LV, Gopal DV (2007) Endoscopic placement of the small-bowel video capsule by using a capsule endoscope delivery device. Gastrointest Endosc 65:842–847
Rosa F, Quero G, Fiorillo C, Doglietto GB, Alfieri S (2019) Billroth II reconstruction in gastric cancer surgery: A good option for Western patients. Am J Surg 218:940–945
Shimoda M, Kubota K, Katoh M, Kita J (2013) Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study. Ann Surg 257:938–942
Ren Z, Wang WX (2019) Comparison of Billroth I, Billroth II, and Roux-en-Y Reconstruction After Totally Laparoscopic Distal Gastrectomy: A Randomized Controlled Study. Adv Ther 36:2997–3006
In Choi C, Baek DH, Lee SH, Hwang SH, Kim DH, Kim KH, Jeon TY, Kim DH (2016) Comparison Between Billroth-II with Braun and Roux-en-Y Reconstruction After Laparoscopic Distal Gastrectomy. J Gastrointest Surg 20:1083–1090
Rondonotti E, Spada C, Adler S, May A, Despott EJ, Koulaouzidis A, Panter S, Domagk D, Fernandez-Urien I, Rahmi G, Riccioni ME, van Hooft JE, Hassan C, Pennazio M (2018) Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 50:423–446
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Study concept and design: KQ, YB, FZ; Literature research: KQ, ZC; Data acquisition: KQ, XF; Data analysis and interpretation: ZC, JZ, TW, XF; Drafting of the manuscript: KQ; All authors reviewed the manuscript and made revisions.
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Drs. Kai Qian, Zhenyu Chen, Jie Zhang, Tianmo Wan, Xicheng Feng, Yang Bai, Fachao Zhi have no conflicts of interest or financial ties to disclose.
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Qian, K., Chen, Z., Zhang, J. et al. Safety and efficacy of small-bowel capsule endoscopy examination in patients with Billroth II gastrojejunostomy. Surg Endosc 36, 75–81 (2022). https://doi.org/10.1007/s00464-020-08239-3
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DOI: https://doi.org/10.1007/s00464-020-08239-3