title: Control of alkaline reflux esophagitis after total gastrectomy by a percutaneous jejunostomy tube.
abstract: Postoperative alkaline reflux esophagitis is a potentially devastating complication after total gastrectomy. The advent of the Roux-en-Y reconstruction has significantly decreased the incidence of this complication. However, when reflux esophagitis occurs, it is often refractory to medical treatment. Even though surgical revision of the Roux-en-Y anastomosis is the management option of choice, affected patients (especially those with advanced metastatic cancers) are often poor surgical candidates. We describe a novel treatment of refractory alkaline reflux esophagitis in a patient after radical total gastrectomy with Roux-en-Y reconstruction for advanced gastric carcinoma. Radiologic placement of a percutaneous jejunostomy tube into the proximal jejunal limb resulted in significant symptomatic relief by external diversion of the pancreaticobiliary drainage, and the procedure was associated with minimal discomfort. Nonsurgical pancreaticobiliary diversion should be considered in those patients with refractory alkaline reflux esophagitis that occurs after total gastrectomy.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. hwanyoo@yahoo.com
authors.forename: Hwan Y
authors.initials: HY
authors.lastname: Yoo
authors.forename: Anthony
authors.initials: A
authors.lastname: Venbrux
authors.forename: Richard
authors.initials: R
authors.lastname: Heitmiller
authors.forename: William J
authors.initials: WJ
authors.lastname: Ravich
authors.forename: Linda A
authors.initials: LA
authors.lastname: Lee
mesh_terms: D004942:Esophagitis, Peptic / Q000209:etiology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007582:Jejunostomy; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery