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Effects of Mosapride Citrate on Patients after Vagal Nerve Preserving Distal Gastrectomy Reconstructed by Interposition of a Jejunal J Pouch with a Jejunal Conduit for Early Gastric Cancer

World Journal of Surgery volume 30, pages 205–212 (2006)Cite this article

Abstract

Background

Vagal nerve–preserving distal gastrectomy reconstructed by interposition of a jejunal J pouch with a jejunal conduit (hereinafter called DGP) is a function-preserving operation for early gastric cancer. However, some patients after DGP have suffered from postprandial stasis in the substitute stomach, and postprandial stasis leads to abdominal symptoms. To clarify the significance of mosapride citrate (MS) for prevention of food stasis in the substitute stomach for patients after DGP, we studied the effects of MS before and after administration of MS.

Materials and Methods

In a total of 18 patients (10 men, 8 women; aged 34 to 70 years, average 63.1 years) during 5 years after DGP for early gastric cancer (Billroth I, D1 + α lymph node dissection, curability A), the relationship between their postoperative quality of life (QOL) and emptying function of the substitute stomach (EFS) was compared using a radioisotope method before MS therapy and after MS therapy at an oral dose of 15 mg/day for 3 months.

Results

(1) Interview. After MS therapy patients evidently had more appetite and ate more, with a slightly increase in body weight (0.5 ∼ 2 kg) compared with patients before MS therapy. Before and after MS therapy no patients had early dumping symptoms, and after MS therapy all patients clearly had fewer symptoms such as reflux esophagitis, nausea, and abdominal pain compared with before MS therapy. After MS therapy they also had significantly decreased abdominal fullness compared with before MS therapy (P = 0.0026). Endoscopically, we found reflux esophagitis in 2 patients from the before MS therapy group but in no patients from the after MS therapy group. All patients in the before MS therapy group showed residual contents in the substitute stomach, and seven patients in the after MS therapy group showed residual contents in the substitute stomach (P < 0.0001). There was a significant difference between before and after MS therapy (P < 0.0001). (2) EFS; The time to 50% residual rate of the before MS therapy group (80.5 ± 16.2 min) was significantly slower than that of the after MS therapy patients (65.6 ± 9.4 min) (P = 0.0091). After MS therapy (28.4% ± 5.2%), the residual rates at 120 minutes were significantly decreased compared with patients before MS therapy (38.2% ± 5.7%) (P = 0.0372).

Conclusions

Patients from the after MS therapy group clearly had improved gastric stasis compared with the before MS therapy group. These results showed more satisfactory QOL in patients after MS therapy. It is possible that MS therapy improves abdominal fullness due to the postprandial stasis in the substitute stomach, contributing to the improvement of QOL of patients after DGP.

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References

  1. Japanese Research Society for Gastric Cancer: Japanese Classification of Gastric Carcinoma (1st English edition), Tokyo, Kanehara, 1995;7–16

    Google Scholar 

  2. Fukuhara H, Imamaura H, Kodera K. The role of surgery in the current treatment of gastric cancer. Gastric Cancer 2002;5:13–16

    Google Scholar 

  3. Shimoyama S, Seto Y, Yasuda H, et al. Concepts, rationale, and current outcomes of less invasive surgical strategies for early gastric cancer: data from a quarter-century of experience in a single institution. World J Surg 2005;29:58–65

    Article  PubMed  Google Scholar 

  4. Woodward ER, Hocking MP. Postgastrectomy syndromes. Surg Clin North Am 1987;67:509–520

    CAS  PubMed  Google Scholar 

  5. Wu CW, Hsieh MC, Lo SS, et al. Quality of life of patients with gastric denocarcinoma after curative gastrectomy. World J Surg 1997;21:777–782

    CAS  PubMed  Google Scholar 

  6. Tomita R, Fujisaki S, Tanjoh K, et al. Relationship between gastroduodenal interdigestive migrating motor complex and quality of life in patients with subtotal gastrectomy for early gastric cancer. Int Surg 2000;85:118–123

    CAS  PubMed  Google Scholar 

  7. Nishikawa K, Kawahara H, Yumiba T, et al. Functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy for early gastric cancer. Surgery 2002;131:613–624

    Article  PubMed  Google Scholar 

  8. Takahashi T, Yoshida M, Kubota T, et al. Morphologic analysis of gastroesophageal reflux diseases in patients after distal gastrectomy. World J Surg 2005;29:50–57

    Article  PubMed  Google Scholar 

  9. Ohya T, Ohwada S, Iesato H, et al. Jejunal pouch interposition after pylorus-preserving gastrectomy. J Surg Res 1999;86:177–182

    Article  CAS  PubMed  Google Scholar 

  10. Iezato H, Ohya T, Ohwada S, et al. Jejunal pouch interposition with an antiperistaltic conduit as a pyloric ring substitute after standard distal gastrectomy: a comparison with the use of an isoperistaltic conduit. Hepatogastroenterology 2000; 47:756–760

    Google Scholar 

  11. Mori Y, Arita T, Shimoda K, et al. Jejunal interposition to prevent postgastrectomy syndroms. Br J Surg 2000; 87:1576–1579

    Google Scholar 

  12. Hida Y, Katoh H. New method for the jejunal pouch interposition reconstruction after distal gastrectomy. Hepatogastroenterology 2000;47:1495–1497

    CAS  PubMed  Google Scholar 

  13. Nomura E, Shinohara H, Mabuchi H, et al. Postoperative evaluation of the jejunal pouch reconstruction following proximal and distal gastrectomy for gastric cancer. Hepatogastroenterology 2004;59:1561–1566

    Google Scholar 

  14. Nakane Y, Michiura T, Inoue K, et al. A randomized clinical trial of pouch reconstruction after total gastrectomy for cancer: which is better technique, Roux-en-Y or interposition? Hepatogastroenterology 2001;48:903–907

    CAS  PubMed  Google Scholar 

  15. Ueno M, Iwahashi M, Nakamori M, et al. Complication of jejunal pouch interposition after proximal gastrectomy: case report. Hepatogastroenterology 2004;57:916–918

    Google Scholar 

  16. Tomita R, Tanjoh K, Fujisaki S. Novel operative technique for vagal nerve- and pyloric sphincter-preserving distal gastrectomy reconstructed by interpostion of a 5 cm jejunal J pouch with a 3 cm jejunal conduit for early gastric cancer and postoperative quality of life 5 years after operation. World J Surg 2004;28:766–774

    Article  PubMed  Google Scholar 

  17. Tomita R, Tanjoh K, Fujisaki S. Relation between gastroduodenal interdigestive migrating motor complex and postoperative gastrointestinal symptoms before and after cisapride therapy following distal gastrectomy for early gastric cancer. World J Surg 2000;24:1250–1257

    Article  CAS  PubMed  Google Scholar 

  18. Ramkumar D, Schulze KS. Gastrointestinal motility. Current Opin Gastroenterol 2003;19:540–545

    CAS  Google Scholar 

  19. Cuomo R, Sarnelli G. Food intake and gastrointestinal motility. A complex interplay. Nutr Metab Cardiovasc Dis 2004;14:173–179

    CAS  PubMed  Google Scholar 

  20. Sakashita M, Yamaguchi T, Miyazaki H, et al. Pharmacokinetics of the astrokinetic agent mosapride citrate after single and multiple oral administrations in healthy subjects. Arzneimittelforschung 1993;43:867–872

    CAS  PubMed  Google Scholar 

  21. Endo J, Nomura N, Morishita S, et al. Influence of mosapride citrate on gastric motility and autonomic nerves functions: evaluation by spectral analyses of heart rate and blood pressures, and by electrogastrography. J Gastroenterol 2002;37:888–895

    Article  CAS  PubMed  Google Scholar 

  22. Asakawa H, Hayashi I, Fukui T, et al. Effect of mosapride on glycemic control and gastric emptying in type 2 diabetes mellitus patients with gastropathy. Diabetes. Res. Clin. Pract. 2003;61:175–182

    Article  CAS  PubMed  Google Scholar 

  23. Maki T, Shiratori T, Hatafuku T, et al. Pylorus-preserving gastrectomy as an improved operation for gastric cancer. Surgery 1967;61:838–845

    CAS  PubMed  Google Scholar 

  24. Tomita R, Takizawa H, Tanjoh K. Physiological effects of cisapride on gastric emptying after pylorus-preserving gastrectomy for early gastric cancer. World J Surg 1998;22:35–40

    CAS  PubMed  Google Scholar 

  25. Imada T, Rino Y, Takahashi M, et al. Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with comventional distal gastrectomy. Surgery 1998;123:165–170

    CAS  PubMed  Google Scholar 

  26. Tomita R, Fujisaki S, Tanjoh K. An operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter and pyloric sphincter for early gastric cancer. World J Surg 2001;25:1524–1531

    CAS  PubMed  Google Scholar 

  27. Behrns KE, Sarr MG. Diagnosis and management of gastric emptying disorders. Adv Surg 1994;27:233–255

    CAS  PubMed  Google Scholar 

  28. Forstner-Barthell AW, Murr MM, Nitecki S, et al. Near-total gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg 1999;3:15–21

    Article  CAS  PubMed  Google Scholar 

  29. Tomita R, Munakat K, Kurosu Y, et al. Gastric emptying time after distal gastrectomy with or without pylorus-preserving. J Smooth Muscle Res 1994;20:229–231

    Google Scholar 

  30. Ruth M, Finizia C, Cange L, et al. The effect of mosapride on esophageal motor function and acid reflux in patients with gastroesophageal reflux disease. Eur J Gastroenterol Hepatol 2003;15:1115–1121

    CAS  PubMed  Google Scholar 

  31. Madan K, Ahuja V, Kashyap PC, et al. Comparison of efficiency of pantoprazole alone versus pantoprazole pulus mosapride in therapy of gastroesophageal reflux disease: a randomized trial. Dis Esophagus 2004;17:274–278

    Article  CAS  PubMed  Google Scholar 

  32. Mine Y, Yoshikawa T, Oku S, et al. Comparison of effect of mosapride citrate and existing 5-HT4 receptor agonists on gastrointestinal motility in vivo and in vitro. J Pharmacol Exp Ther 1997;283:1000–1008

    CAS  PubMed  Google Scholar 

  33. Mayer JH, McGregor IL, Gueller R. 99mTc-tagged chicken liver as a maker of solid food in human stomach. Dig Dis Sci 1976;21:296–230

    Google Scholar 

  34. Shiratori T, Hongo M, Ishii M. Interpretation of gastric emptying curve by RI method. J Smooth Muscle Res 1994;30:433–437

    Google Scholar 

  35. Calvert EL, Whorwell PJ, Houghton LA. Inter-digestive and post-prandial antro-pyloro-duodenal motor activity in humans: effect of 5-hydroxytryptamine 1 receptor agonist. Aliment Pharmacol Ther 2004;19:805–815

    Article  CAS  PubMed  Google Scholar 

  36. Itoh H, Nagano T, Takeyama M. Effects of mosapride citrate on human plasma levels of motilin, gastrin, somatostatin, and secretin. Biol Pharm Bull 2001;24:1072–1075

    Article  CAS  PubMed  Google Scholar 

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Affiliations

  1. Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, 2-3-16 Fujimi, Chiyoda-ku, Tokyo, 102-8158, Japan

    Ryouichi Tomita MD, PhD

  2. First Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-0032, Japan

    Ryouichi Tomita MD, PhD, Taro Ikeda MD, PhD, Shigeru Fujisaki MD, PhD, Tugumichi Koshinaga MD, PhD & Katsuhisa Tanjoh MD, PhD

Authors
  1. Ryouichi Tomita MD, PhD
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  2. Taro Ikeda MD, PhD
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  3. Shigeru Fujisaki MD, PhD
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  4. Tugumichi Koshinaga MD, PhD
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  5. Katsuhisa Tanjoh MD, PhD
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Correspondence to Ryouichi Tomita MD, PhD.

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Tomita, R., Ikeda, T., Fujisaki, S. et al. Effects of Mosapride Citrate on Patients after Vagal Nerve Preserving Distal Gastrectomy Reconstructed by Interposition of a Jejunal J Pouch with a Jejunal Conduit for Early Gastric Cancer. World J. Surg. 30, 205–212 (2006). https://doi.org/10.1007/s00268-005-7979-6

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  • DOI: https://doi.org/10.1007/s00268-005-7979-6

Keywords

  • Early Gastric Cancer
  • Reflux Esophagitis
  • Distal Gastrectomy
  • Enteric Nervous System
  • Vagal Nerve