Duodenogastric reflux induced by endoscopic submucosal dissection.
OBJECTIVE
Endoscopic submucosal dissection (ESD) may cause excessive duodenogastric reflux (DGR) in a similar manner to distal gastrectomy, particularly after antral resections. We aimed to examine the occurrence of DGR after ESD.


METHODS
Patients with gastric neoplasm for whom ESD was indicated were categorized according to lesion site: the antral group (lower [L] stomach, n = 46) and the nonantral group (upper or middle [U or M] stomach, n = 49). Endoscopy was performed before ESD, the day after ESD, and 3 months after ESD, and the fasting bile acid concentration (BAC) in the gastric juice was analyzed.


RESULTS
BAC values showed significant interaction between time point and group, although this association differed in the antral and nonantral groups. BACs on the day after ESD were higher in the antral group than in the nonantral group, but not the pre-ESD and 3 months post-ESD levels. In the antral group only, fasting BACs increased significantly the day after ESD and decreased to baseline levels 3 months post-ESD. There was also a correlation between BAC and lesion location in the antral subgroups, with significantly higher BACs found the day after ESD in patients with lesser curvature lesions.


CONCLUSIONS
ESD of lesions in the antral lesser curvature may lead to a transient early increase in DGR. However, ESD does not result in long-term DGR, a factor that is known to increase the risk of carcinogenesis following gastrectomy.
Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo 113-8603, Japan. km366@nms.ac.jp
K
K
Miyake
M
M
Kusunoki
T
T
Shindo
N
N
Ueki
T
T
Kawagoe
K
K
Gudis
A
A
Tatsuguchi
S
S
Futagami
T
T
Tsukui
C
C
Sakamoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001647:Bile Acids and Salts / Q000032:analysis; D004210:Dissection / Q000009:adverse effects*; D004383:Duodenogastric Reflux / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
D001647:Bile Acids and Salts