scholarly journals Severe reflux esophagitis after total gastrectomy successfully treated by transposition of the jejunojejunal anastomosis: a report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Noriyuki Nishiwaki ◽  
Shinji Hato ◽  
Tetsuya Kagawa ◽  
Tomokazu Kakishita ◽  
Isao Nozaki
Keyword(s):  
Gastric Cancer ◽  
Effective Treatment ◽  
Total Gastrectomy ◽  
Medical Therapy ◽  
Reflux Esophagitis ◽  
Pathological Diagnosis ◽  
Stage Iiic ◽  
Case Presentation ◽  
Oral Medications

Abstract Background Reflux esophagitis after total gastrectomy is often difficult to treat. In this report, we describe two cases of reflux esophagitis that were refractory to medical therapy and successfully treated by transposition of the jejunojejunal anastomosis. Case presentation Case 1: A 66-year-old man underwent total gastrectomy and cholecystectomy for gastric cancer, and Roux-en-Y (RY) reconstruction was performed. The pathological diagnosis was T4aN3aM0 stage IIIC. Five months later, esophagogastroduodenoscopy identified reflux esophagitis. Although he was treated with various oral medications and was hospitalized six times, he lost 19 kg of weight. Finally, the patient was reoperated 3 years postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions that could have caused obstruction, and the anastomotic distance between the esophagojejunostomy and the jejunojejunostomy was approximately 40 cm. The jejunojejunostomy was re-anastomosed to increase the distance to 100 cm. Two years and 6 months after the reoperation, there was no recurrence of reflux esophagitis, and the patient’s weight increased by 14 kg. Case 2: A 68-year-old woman underwent total gastrectomy and cholecystectomy for gastric cancer, and RY reconstruction was performed. The pathological diagnosis was T4aN0M0 stage IIB. Similar to Case 1, the patient was diagnosed with reflux esophagitis 5 months later. She lost 23 kg of weight and was reoperated at 6 months postoperatively. Intraoperative findings showed that there was no evidence of recurrence or severe adhesions, and transposition of the jejunojejunostomy was performed to increase the distance between anastomoses from 40 to 100 cm. Two years and 8 months after the reoperation, there was no recurrence of reflux esophagitis, and her weight increased by 15 kg. Conclusions Transposition of the jejunojejunostomy was an effective treatment for medication-resistant severe reflux esophagitis after total gastrectomy.

scholarly journals A CASE OF GASTRIC CANCER WITH MALROTATION OF INTESTINE REQUIRED RE-OPERATION FOR REFLUX ESOPHAGITIS AFTER TOTAL GASTRECTOMY

2006 ◽  
Vol 67 (3) ◽  
pp. 620-624 ◽  
Author(s):  
Fumiaki KAWANO ◽  
Ryo SEKIYA ◽  
Tatsuo SHINOHARA ◽  
Hirofumi UCHINO ◽  
Toshio ONITSUKA
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Reflux Esophagitis

Preservation of the lower esophageal sphincter during total gastrectomy for gastric cancer to prevent postoperative reflux esophagitis

Surgery Today ◽  
1995 ◽  
Vol 25 (6) ◽  
pp. 507-514 ◽  
Author(s):  
Toshihiro Hirai ◽  
Shuji Saeki ◽  
Kei Matsuki ◽  
Yoshinori Yamashita ◽  
Takashi Iwata ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Lower Esophageal Sphincter ◽  
Reflux Esophagitis ◽  
Postoperative Reflux ◽  
Esophageal Sphincter

scholarly journals Significance of the Lower Esophageal Sphincter Preservation in Preventing Alkaline Reflux Esophagitis in Patients After Total Gastrectomy Reconstructed by Roux-en-Y for Gastric Cancer

2014 ◽  
Vol 99 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Ryouichi Tomita ◽  
Kenichi Sakurai ◽  
Shigeru Fujisaki
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Lower Esophageal Sphincter ◽  
Reflux Esophagitis ◽  
Ph Monitoring ◽  
Sphincter Preservation ◽  
Esophageal Ph ◽  
Group A ◽  
Esophageal Sphincter ◽  
Alkaline Reflux

Abstract To clarify the significance of the lower esophageal sphincter (LES) for prevention of alkaline reflux esophagitis (ARE) after total gastrectomy reconstructed by Roux-en-Y (TGRY) for gastric cancer, we investigated LES function and lower esophageal pH in TGRY patients with or without LES preservation. A total of 51 patients 5 years after TGRY were divided into groups A (26 patients without preserved LES) and B (25 patients with preserved LES) and compared with 22 control participants (group C). Manometric study and ambulatory 24-hour esophageal pH monitoring were performed on all patients. Symptomatic and endoscopic AREs in group A were significantly higher than those in group B (P < 0.05). The length of LES and maximum LES pressure in group A were significantly shorter and lower, respectively, than in groups B and C (P < 0.01). The length of LES and maximum LES pressure in patients with symptomatic ARE were significantly shorter and lower, respectively, than in patients without symptomatic ARE (P < 0.01). Percentages of time with pH >7 and pH >8 within 24 hours in group A were significantly higher than those in groups B and C (P < 0.01). Preservation of the LES may be necessary to prevent ARE after TGRY.

scholarly journals Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Peirong Tian ◽  
Yang Liu ◽  
Shibo Bian ◽  
Mengyi Li ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
Anastomotic Stenosis ◽  
Proximal Gastric Cancer ◽  
Laparoscopic Proximal Gastrectomy

BackgroundTo compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer.MethodsOriginal English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer).ResultsFourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = −13.33, 95% CI: −15.66 to −11.00, P < 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = −42.51, 95% CI: −58.99 to −26.03, P < 0.00001), less intraoperative blood loss (WMD = −79.52, 95% CI: −116.63 to −42.41, P < 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG.ConclusionLPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.

scholarly journals A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

2019 ◽  
Author(s):  
Shengnan Li ◽  
Lihu Gu ◽  
Zefeng Shen ◽  
Danyi Mao ◽  
Parikshit Asutosh Khadaroo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Vitamin B12 ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Meta Analysis ◽  
Proximal Gastrectomy ◽  
Cochrane Library ◽  
Clinical Effects ◽  
Double Tract Reconstruction

Abstract Background In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. Methods The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. Results The results showed no significant difference in the anastomotic stenosis (OR=0.91, 95%CI=0.33-2.50, p=0.85) and reflux esophagitis (OR=1.87, 95%CI=0.62-5.65, p=0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR=0.06, 95%Cl=0.01-0.59, p=0.02). Conclusions Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.

scholarly journals A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

2019 ◽  
Author(s):  
Shengnan Li ◽  
Lihu Gu ◽  
Zefeng Shen ◽  
Danyi Mao ◽  
Parikshit Asutosh Khadaroo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Vitamin B12 ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Meta Analysis ◽  
Proximal Gastrectomy ◽  
Cochrane Library ◽  
Clinical Effects ◽  
Double Tract Reconstruction

Abstract Background In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. Methods The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. Results The results showed no significant difference in the anastomotic stenosis (OR=0.91, 95%CI=0.33-2.50, p=0.85) and reflux esophagitis (OR=1.87, 95%CI=0.62-5.65, p=0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR=0.06, 95%Cl=0.01-0.59, p=0.02). Conclusions Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.

Identification of novel autoantibodies in ascites of relapsed paclitaxel-resistant gastric cancer with peritoneal metastasis using immunome protein microarrays and proteomics

2021 ◽  
pp. 1-10
Author(s):  
Zhongyin Yang ◽  
Chao Yan ◽  
Wentao Liu ◽  
Wei Xu ◽  
Chen Li ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Effective Treatment ◽  
Peritoneal Metastasis ◽  
Quantitative Proteomics ◽  
Poor Prognosis ◽  
Protein Microarrays ◽  
Tandem Mass ◽  
Tandem Mass Tag ◽  
Resistant Group ◽  
Potential Biomarkers

BACKGROUND: Gastric cancer (GC) patients with peritoneal metastasis usually have extremely poor prognosis. Intraperitoneal infusion of paclitaxel (PTX) provides an effective treatment, but relapse and PTX-resistance are unavoidable disadvantages, and it is difficult to monitor the occurrence of PTX-resistance. OBJECTIVE: The aim of this study was to explore novel autoantibodies in the ascites of individuals with relapsed PTX-resistant GC with peritoneal metastasis. METHODS: Ascites samples were collected before PTX infusion and after the relapse in 3 GC patients. To determine the expression of significantly changed proteins, we performed autoantibody profiling with immunome protein microarrays and tandem mass tag (TMT) quantitative proteomics, and then, the overlapping proteins were selected. RESULTS: Thirty-eight autoantibodies that were differentially expressed between the ascites in the untreated group and relapsed PTX-resistant group were identified. For confirmation of the results, TMT quantitative proteomics was performed, and 842 dysregulated proteins were identified. Four proteins, TPM3, EFHD2, KRT19 and vimentin, overlapped between these two assays. CONCLUSIONS: Our results first revealed that TPM3, EFHD2, KRT19 and vimentin were novel autoantibodies in the ascites of relapsed PTX-resistant GC patients. These autoantibodies may be used as potential biomarkers to monitor the occurrence of PTX-resistance.

scholarly journals A 60-year-old woman with asymptomatic total thoracic–abdominal aortic aneurysm

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jianying Deng ◽  
Wei Liu
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Effective Treatment ◽  
Clinical Symptoms ◽  
Aortic Aneurysms ◽  
Case Presentation ◽  
Second Stage ◽  
Aortic Replacement ◽  
Abdominal Aortic ◽  
Thoracoabdominal Aortic Replacement

Abstract Introduction Total thoracic–abdominal aortic aneurysm is a rare disease in cardiovascular surgery, with high surgical risk and high mortality. Surgery is considered the most effective treatment for total aortic aneurysms. Case presentation Our group admitted a 60-year-old female patients with asymptomatic complex total thoracic–abdominal aortic aneurysm, and successfully performed two-staged surgery, namely Bentall + Sun’s operation in the first-stage and thoracoabdominal aortic replacement in the second-stage. The results of the surgery were satisfactory. Conclusions Patients with total thoracic–abdominal aortic aneurysm may not have typical clinical symptoms and require a careful and comprehensive physical examination and related auxiliary examinations by clinicians. Staged repair of total thoracic–abdominal aortic aneurysms is still a safe and effective treatment.

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