Reflux esophagitis after total gastrectomy with jejunal pouch reconstruction: comparison of long and short pouches.
OBJECTIVE
To evaluate the effect of the type of jejunal pouch (long or short) on reflux esophagitis after total gastrectomy.


METHODS
Two groups of patients who underwent jejunal pouch reconstruction (long pouch, n = 9; short pouch, n = 9) after total gastrectomy were compared, and each was also compared with a group of healthy control subjects (n = 9). Reflux symptoms were assessed using a reflux score questionnaire derived from Moran's graded reflux questionnaire. Scintigraphy was performed to evaluate quantitatively intestinoesophageal reflux and pouch emptying time (t75%).


RESULTS
Heartburn was more common in the long pouch group than in the short pouch group (56 vs 11%, p < 0.05), and the reflux score was significantly higher in the long pouch group (mean score 3.0 vs 1.0, p < 0.01). The scintigraphic reflux index in the long pouch group, short pouch group, and control group was 9.57 +/- 5.52, 7.05 +/- 3.35, and 1.55 +/- 0.70, respectively. The reflux index in the entire group of patients was significantly higher than that in the control group (p < 0.005). In addition, t75% was significantly longer in the long pouch group (46.0 +/- 16.2 min) than in the short pouch group (21.1 +/- 15.39 min).


CONCLUSIONS
Our findings suggest that reconstruction with a short jejunal pouch is more effective than a long pouch in preventing reflux symptoms.
Tanaka
T
T
Second Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Fujiwara
Y
Y
Nakagawa
K
K
Kusunoki
M
M
Utunomiya
J
J
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D004942:Esophagitis, Peptic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D011795:Surveys and Questionnaires; D016896:Treatment Outcome