title: Impact of the biliary diversion procedure on carcinogenesis in Barrett's esophagus surgically induced by duodenoesophageal reflux in rats.
abstract: OBJECTIVE
  To determine whether the elimination of bile reflux in the established esophagojejunostomy model of Barrett's esophagus (BE) will reduce or eliminate the risk of developing esophageal adenocarcinoma.
  
  
  BACKGROUND
  Reflux of duodenal juice as well as gastric acid plays an important role in the pathogenesis of BE and adenocarcinoma. Duodenoesophageal reflux (DER) per se induces these diseases without carcinogen. However, it is unclear whether antireflux surgery induces regression of BE and prevents adenocarcinoma.
  
  
  METHODS
  Two hundred F344 male rats underwent one of following 3 operations: (1) total gastrectomy and esophagojejunostomy to induce DER, followed by killing after 20 (n = 13), 30 (n = 12), and 50 weeks (n = 30); (2) biliary diversion procedure, converted to Roux-en-Y method, to avoid bile regurgitation into the esophagus at 20 (n = 29) and 30 weeks (n = 32) after the operation to induce DER, followed by killing 50 weeks after initial operation; or (3) total gastrectomy and Roux-en-Y esophagojejunostomy followed by killing after 50 weeks served as controls (n = 28).
  
  
  RESULTS
  BE developed in more than half of the animals exposed to DER for 20 weeks, in more than 90% of rats with DER for 30 weeks, and in 100% of animals exposed to DER for 50 weeks. In the incidence and the length of BE, there is no difference between the animals that underwent biliary diversion at 20 (62%) and 30 weeks (94%) and those that had DER for 20 (54%) and 30 weeks (92%), respectively. Incidence of adenocarcinoma was significantly lower in the rats that underwent the biliary diversion procedure after 30 (19%) and 20 weeks (3%) than in the rats that had DER for 50 weeks (60%) (P < 0.005). None of the control animals that underwent Roux-en-Y esophagojejunostomy developed BE and carcinoma.
  
  
  CONCLUSIONS
  It is likely that the converting procedure from the esophagojejunostomy to induce DER to biliary diversion does not lead to regression of BE but prevents the development of esophageal adenocarcinoma in the rats.
authors.affiliation: Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nishijima
authors.forename: Koichi
authors.initials: K
authors.lastname: Miwa
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Miyashita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kinami
authors.forename: Itasu
authors.initials: I
authors.lastname: Ninomiya
authors.forename: Sachio
authors.initials: S
authors.lastname: Fushida
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujimura
authors.forename: Takanori
authors.initials: T
authors.lastname: Hattori
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D000818:Animals; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology*; D004383:Duodenogastric Reflux / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D004938:Esophageal Neoplasms / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005743:Gastrectomy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D008297:Male; D051381:Rats; D011916:Rats, Inbred F344