title: Reflux esophagitis and marginal ulcer after pancreaticoduodenectomy.
abstract: BACKGROUND
  Reflux esophagitis is a common complication following a distal gastrectomy. Increasingly, Roux-en-Y reconstruction has been used to prevent reflux esophagitis; however, marginal ulcer is a concern in patients with a Roux-en-Y reconstruction after distal gastrectomy. The effect of Roux-en-Y reconstruction on the development of reflux esophagitis and marginal ulcer after pancreaticoduodenectomy (PD) has not been studied.
  
  
  METHODS
  We retrospectively studied both reflux esophagitis and marginal ulcer after 371 PDs and analyzed the association with different methods of gastrointestinal reconstruction.
  
  
  RESULTS
  In a median follow-up time of 20 months, 40 (10.8%) of the 371 patients developed reflux esophagitis, 15 after 158 standard PD, and 25 after 213 pylorus-preserving pancreaticoduodenectomy (PPPD; P = 0.62). Cox regression model showed Roux-en-Y reconstruction was significantly inversely related to occurrence of reflux esophagitis in 158 patients after standard PD (P = 0.04) but not in 213 patients after PPPD (P = 0.24). Thirty-five of 371 studied patients developed marginal ulcer, 15 after standard PD and 20 after PPPD (P = 0.45). Multivariate analysis showed that Roux-en-Y reconstruction was the only significant predictor for marginal ulcer after PD (P = 0.02).
  
  
  CONCLUSIONS
  Our data support the use of Roux-en-Y reconstruction after standard PD but not after PPPD.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Rd, 10002, Taipei, Taiwan, Republic of China.
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Wu
authors.forename: Meng-Kun
authors.initials: MK
authors.lastname: Tsai
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.forename: Kin-Jen
authors.initials: KJ
authors.lastname: Chang
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Tien
mesh_terms: D001649:Bile Duct Diseases / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology