Preoperative determination of appropriate cutting line for proximal gastrectomy to avoid postoperative jejunal ulcer.
OBJECTIVE
Although proximal gastrectomy has become a procedure of choice for patients' early cancer in the upper third of stomach, no clinical guide for optimal gastric resection in order to avoid postoperative jejunal ulcer is available. The aim of this study was to investigate whether determining the distribution of parietal and chief cells of the stomach using Congo red test is clinically relevant.


METHODS
The F-line was defined as a boundary line between fundic and intermediate area of the stomach according to the pathological findings in 29 patients who underwent total gastrectomy for early gastric cancer, whereas the f-line was regarded as a boundary line between intermediate and pyloric area. In the additional 6 patients undergoing vagus-preserving proximal gastrectomy with jejunal pouch interposition, endoscopic Congo red test was preoperatively performed to determine the F-f-line.


RESULTS
The distances from the pyloric ring to f-line on the lesser and greater curvatures were variable. Long-term outcomes of proximal gastrectomy guided by preoperative endoscopic Congo red test were favorable.


CONCLUSIONS
It is suggested that preoperative endoscopic Congo red test is useful to determine the appropriate cutting line in order to avoid postoperative jejunal ulcer after proximal gastrectomy.
The Jikei University School of Medicine, Department of Surgery, Tokyo, Japan. ntakahashi@jikei.ac.jp
Naoto
N
Takahashi
Hirotaka
H
Kashimura
Hiroshi
H
Nimura
Atsushi
A
Watanabe
Kentaro
K
Yano
Hiroaki
H
Aoki
Tomoki
T
Koyama
Toshiyuki
T
Sasaki
Atsuo
A
Shida
Norio
N
Mitsumori
Teruaki
T
Aoki
Hideyuki
H
Kashiwagi
Katsuhiko
K
Yanaga
D019872:Chief Cells, Gastric / Q000166:cytology; D004396:Coloring Agents; D003224:Congo Red; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D007579:Jejunal Diseases / Q000209:etiology* / Q000517:prevention & control; D010295:Parietal Cells, Gastric / Q000166:cytology; D011300:Preoperative Care; D013274:Stomach Neoplasms / Q000601:surgery*; D014456:Ulcer / Q000209:etiology* / Q000517:prevention & control
D004396:Coloring Agents; D003224:Congo Red