Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy

  • Kei Matsumoto (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Shinwa Tanaka (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Takashi Toyonaga (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Nobuaki Ikezawa (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Mari Nishio (Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine) ;
  • Masanao Uraoka (Department of Gastroenterology, Kishiwada Tokushukai Hospital) ;
  • Tomoatsu Yoshihara (Department of Gastroenterology, Kishiwada Tokushukai Hospital) ;
  • Hiroya Sakaguchi (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Hirofumi Abe (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Tetsuya Yoshizaki (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Madoka Takao (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Toshitatsu Takao (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Yoshinori Morita (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Hiroshi Yokozaki (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Yuzo Kodama (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University)
  • Received : 2021.02.25
  • Accepted : 2021.05.18
  • Published : 2022.01.30
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Abstract

Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and nonBillroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

Keywords

References

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