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Roux-en-Y Reconstruction is Superior to Billroth I Reconstruction in Reducing Reflux Esophagitis After Distal Gastrectomy: Special Relationship with the Angle of His

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Abstract

Background

The aim of the present study was to evaluate the relationship between the angle of His in Roux-en-Y (RY) or Billroth I (BI) reconstruction and reflux esophagitis after distal gastrectomy for gastric cancer.

Methods

Results for 47 patients undergoing BI reconstruction and 38 patients undergoing RY reconstruction were examined retrospectively. The angle of His and the incidence of reflux esophagitis were determined, and the quality of life (QOL) was evaluated with the Gastrointestinal Symptom Rating Scale (GSRS).

Results

The angle of His was significantly greater in patients who underwent BI compared with RY reconstruction, as well as in patients with reflux esophagitis. Scores for reflux, diarrhea, and total symptoms on the GSRS were significantly better in the RY group than in the BI group.

Conclusions

The angle of His is an important determinant of reflux esophagitis following distal gastrectomy. The decreased angle of His in patients after RY compared with BI reconstruction may contribute significantly to the reduced incidence of reflux esophagitis and improved QOL in patients who undergo RY reconstruction.

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References

  1. Yoshino K (2000) History of gastric cancer surgery. J Jpn Surg Soc 101:855–860

    CAS  Google Scholar 

  2. Weil PH, Buchberger R (1999) From Billroth to PCV: a century of gastric surgery. World J Surg 23:736–742

    Article  CAS  PubMed  Google Scholar 

  3. Fukuhara K, Osugi H, Takada N et al (2004) Correlation between duodenogastric reflux and remnant gastritis after distal gastrectomy. Hepatogastroenterology 51:1241–1244

    PubMed  Google Scholar 

  4. Shinoto K, Ochiai T, Suzuki T et al (2003) Effectiveness of Roux-en-Y reconstruction after distal gastrectomy based on an assessment of biliary kinetics. Surg Today 33:169–177

    Article  PubMed  Google Scholar 

  5. Miwa K, Hasegawa H, Fujimura T et al (1992) Duodenal reflux after through the pylorus induces gastric adenocarcinoma in the rat. Carcinogenesis 13:2313–2316

    Article  CAS  PubMed  Google Scholar 

  6. Fukuhara K, Osugi H, Takada N et al (2002) Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J Surg 26:1452–1457

    Article  PubMed  Google Scholar 

  7. Osugi H, Fukuhara K, Takada N et al (2004) Reconstructive procedure after distal gastrectomy to prevent remnant gastritis. Hepatogastroenterology 51:1215–1218

    CAS  PubMed  Google Scholar 

  8. Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English Edition. Gastric Cancer 1:10–24

    Article  PubMed  Google Scholar 

  9. Armstrong D, Bennett JR, Blum AL et al (1996) The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 111:85–92

    Article  CAS  PubMed  Google Scholar 

  10. Hoshihara Y (2004) Endoscopic findings of GERD. Nippon Rinsho 62:1459–1464

    PubMed  Google Scholar 

  11. Kiesslich R, Kanzler S, Vieth M et al (2004) Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy. Dig Dis 22:221–227

    Article  CAS  PubMed  Google Scholar 

  12. Hongo M (2006) Minimal changes in reflux esophagitis: red ones and white ones. J Gastroenterol 41:95–99

    Article  PubMed  Google Scholar 

  13. Kusano M, Shirai N, Yamaguchi K et al (2008) It is possible to classify non-erosive reflux disease (NERD) patients into endoscopically normal groups and minimal change groups by subjective symptoms and responsiveness to rabeprazole: a report from a study with Japanese patients. Dig Dis Sci 53:3082–3094

    Article  CAS  PubMed  Google Scholar 

  14. Kubo M, Sasako M, Gotoda T et al (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89

    Article  PubMed  Google Scholar 

  15. Svedlund J, Sjodin I, Dotevall G (1988) GSRS—a clinical rating score for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 33:129–134

    Article  CAS  PubMed  Google Scholar 

  16. Revicki DA, Wood M, Wiklund I et al (1998) Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res 7:75–83

    Article  CAS  PubMed  Google Scholar 

  17. Kulich KR, Madisch A, Pacini F et al (2008) Reliability and validity of the gastrointestinal symptom rating scale (GSRS) and quality of life in reflux and dyspepsia (QOLRAD) questionnaire in dyspepsia: a six-country study. Health Qual Life Outcomes 31:6–12

    Google Scholar 

  18. Montesani C, D’Amato A, Santella S et al (2002) Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy: perspective randomized study. Hepatogastroenterology 49:1469–1473

    PubMed  Google Scholar 

  19. Ishikawa M, Kitayama J, Kaizaki S et al (2005) Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg 29:1415–1420

    Article  PubMed  Google Scholar 

  20. Mittal RK, Holloway RH, Penagini R et al (1995) Transient lower esophageal sphincter relaxation. Gastroenterology 109:601–610

    Article  CAS  PubMed  Google Scholar 

  21. Schwizer W, Hinder RA, DeMeester TR (1989) Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg 157:74–81

    Article  CAS  PubMed  Google Scholar 

  22. Paterson EG (2001) The normal antireflux mechanism. Chest Surg Clin North Am 11:473–483

    CAS  Google Scholar 

  23. Marchard P (1955) The gastroesophageal sphincter and the mechanism of regurgitation. Br J Surg 42:504–513

    Article  Google Scholar 

  24. His W (1903) Studien an geharteten leichen uber form und lagerong des mensch lichen magens. Arch Anat Entw Gesch 345–367

  25. Munzer D (1997) Angle of His in the cardioesophageal junction: is it a primordial factor in reflux esophagitis? Scand J Gastroenterol 32:847

    Article  CAS  PubMed  Google Scholar 

  26. Fujiwara Y, Nakagawa K, Kusunoki M et al (1998) Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of His. Am J Gastroenterol 93:11–15

    Article  CAS  PubMed  Google Scholar 

  27. Halkiewicz F, Kasner J, Karczewska K et al (2000) Ultrasound picture of gastroesophageal junction in children with reflux disease. Med Sci Monit 6:96–99

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  29. Nunobe S, Okaro A, Sasako M et al (2007) Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years. Int J Clin Oncol 12:433–439

    Article  PubMed  Google Scholar 

  30. Vaezi MF, Richter JE (1997) Contribution of acid and duodenogastro-oesophageal reflux to oesophageal mucosal injury and symptoms in partial gastrectomy patients. Gut 41:297–302

    Article  CAS  PubMed  Google Scholar 

  31. Chan DC, Fan YM, Lin CK et al (2007) Roux-en-Y reconstruction after distal gastrectomy to reduce enterogastric reflux and Helicobacter pylori infection. J Gastrointest Surg 11:1732–1740

    Article  PubMed  Google Scholar 

  32. Hintze RE, Adler A, Veltzke W et al (1997) Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy 29:69–73

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan

    Tsutomu Namikawa, Hiroyuki Kitagawa, Takehiro Okabayashi, Takeki Sugimoto & Kazuhiro Hanazaki

  2. Department of Human Health and Medical Sciences, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan

    Michiya Kobayashi

Authors
  1. Tsutomu Namikawa
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  2. Hiroyuki Kitagawa
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  3. Takehiro Okabayashi
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  4. Takeki Sugimoto
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  5. Michiya Kobayashi
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  6. Kazuhiro Hanazaki
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Correspondence to Tsutomu Namikawa.

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Namikawa, T., Kitagawa, H., Okabayashi, T. et al. Roux-en-Y Reconstruction is Superior to Billroth I Reconstruction in Reducing Reflux Esophagitis After Distal Gastrectomy: Special Relationship with the Angle of His. World J Surg 34, 1022–1027 (2010). https://doi.org/10.1007/s00268-010-0452-1

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  • DOI: https://doi.org/10.1007/s00268-010-0452-1

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