Clin Endosc.  2022 Jan;55(1):86-94. 10.5946/ce.2021.084.

Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy

• Matsumoto K
• Tanaka S
• Toyonaga T
• Ikezawa N
• Nishio M
• Uraoka M
• Yoshihara T
• Sakaguchi H
• Abe H
• Yoshizaki T
• Takao M
• Takao T
• Morita Y
• Yokozaki H
• Kodama Y

• KMID: 2525054
• DOI: http://doi.org/10.5946/ce.2021.084

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 non-Billroth 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.

Keyword

Bleeding; Duodenogastric reflux; Endoscopic submucosal dissection; Gastrectomy; Gastric cancer

Figure

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  Fig. 1. Endoscopic grading of remnant gastritis. (A) Grade 0, normal mucosa. (B) Grade 1, mild redness. (C) Grade 2, intermediate grade (between grades 1 and 3). (D) Grade 3, severe redness. (E) Grade 4, apparent erosion.

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  Fig. 2. Pathological grading of remnant gastritis (neutrophils). (A) 0, absent. (B) 1, mild. (C) 2, moderate. (D) 3, severe.

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  Fig. 3. Pathological grading of remnant gastritis (mononuclear cells). (A) 0, absent. (B) 1, mild. (C) 2, moderate. (D) 3, severe.

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  Fig. 4. Remnant gastric cancers at the anastomotic sites after Billroth II. (A) White light observation. (B) After spraying indigo carmine.

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