Clinical Endoscopy

Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review: Renato Medas, Eduardo Rodrigues-Pinto; Clin Endosc 2023;56(6):693-705. Published online July 3, 2023; DOI: https://doi.org/10.5946/ce.2023.043

Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.

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Intravaginal endoscopic vacuum therapy of a rectovaginal fistula: expanding boundaries
Renato Medas, Guilherme Macedo, Eduardo Rodrigues-Pinto
Endoscopy.2025; 57(S 01): E30. CrossRef
Post-Surgical Leaks of the Upper Digestive Tract – The Importance of an Early Endoscopic Approach
I Tarrio, A Andrade, A R Ribeiro, M Moreira, T Araújo, L Lopes
Endoscopy.2025; 57(S 02): S298. CrossRef
Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review
Tan Minh Le, Van Huy Tran, Kyu Sung Chung, Seong Woo Jeon
Clinical Endoscopy.2025; 58(2): 181. CrossRef
RESULTS OF THE APPLICATION OF ENDOSURGICAL TECHNOLOGIES IN THE DIAGNOSIS AND TREATMENT OF EARLY INTRAABDOMINAL COMPLICATIONS IN POSTOPERATIVE PERIOD
I. A. Yusubov, E. Y. Sharifov
World of Medicine and Biology.2024; 20(89): 184. CrossRef

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Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy: Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama; Clin Endosc 2022;55(1):86-94. Published online August 13, 2021; DOI: https://doi.org/10.5946/ce.2021.084

Abstract PDF Supplementary Material PubReader ePub: 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.

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A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection: Paraskevas Gkolfakis, Marc-André Bureau, Marianna Arvanitakis, Jacques Devière, Daniel Blero; Clin Endosc 2022;55(1):141-145. Published online April 16, 2021; DOI: https://doi.org/10.5946/ce.2021.033

Abstract PDF PubReader ePub

A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient’s symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

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Management of leakage and fistulas after bariatric surgery
Stephen A. Firkins, Roberto Simons-Linares
Best Practice & Research Clinical Gastroenterology.2024; 70: 101926. CrossRef
Role of Endoscopic Internal Drainage in Treating Gastro-Bronchial and Gastro-Colic Fistula After Sleeve Gastrectomy
Alessandra D’Alessandro, Giovanni Galasso, Francesco Paolo Zito, Cristiano Giardiello, Fabrizio Cereatti, Roberto Arienzo, Filippo Pacini, Jean-Marc Chevallier, Gianfranco Donatelli
Obesity Surgery.2022; 32(2): 342. CrossRef

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Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients: Erkan Caglar, Deniz Atasoy, Mukaddes Tozlu, Engin Altınkaya, Serkan Dogan, Hakan Senturk; Clin Endosc 2020;53(1):82-89. Published online September 3, 2019; DOI: https://doi.org/10.5946/ce.2019.073

Abstract PDF PubReader ePub

Background
/Aims: Altered anatomy is a challenge in endoscopic retrograde cholangiopancreatography (ERCP) for patients with Billroth II anastomosis. In this study, we investigated the overall success and role of endoscopist experience.
Methods
Data of patients who underwent ERCP between 2014 and 2018 after a previous Billroth II operation were retrieved retrospectively from 2 tertiary ERCP centers. The procedures were performed by 2 endoscopists with different levels of experience. Clinical success was defined as extraction of the stone, placement of a stent through a malignant stricture, and clinical and laboratory improvements in patients.
Results
Seventy-five patients were included. The technical success rate was 83% for the experienced endoscopist and 75% for the inexperienced endoscopist (p=0.46). The mean (±standard deviation) procedure time was 23.8±5.7 min for the experienced endoscopist and 40.68±6.07 min for the inexperienced endoscopist (p<0.001). In total, 3 perforations (4%) were found. The rate of afferent loop perforation was 6.25% (1/16) for the inexperienced endoscopist and 0% (0/59) for the experienced endoscopist (p=0.053).
Conclusions
ERCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopist who should beware of the unique adverse events related to ERCP in patients with altered anatomy.

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Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
BMC Gastroenterology.2025;[Epub] CrossRef
Practical application of the modification in endoscopic retrograde cholangiopancreatography treated common bile duct stones in patients with Billroth II gastroenterostomy in Vietnam
Tran Thi Anh Tuyet, Nguyen Van Thai, Nguyen Tien Thinh, Mai Thanh Binh
Therapeutic Advances in Gastrointestinal Endoscopy.2024;[Epub] CrossRef
Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
Ru-Yi Wang, Zhen Fan
World Chinese Journal of Digestology.2024; 32(7): 490. CrossRef
Efficacy and safety of a single-use cholangioscope for percutaneous transhepatic cholangioscopy
Ivo Boskoski, Torsten Beyna, James YW Lau, Arnaud Lemmers, Mehran Fotoohi, Mohan Ramchandani, Valerio Pontecorvi, Joyce Peetermans, Eran Shlomovitz
Endoscopy International Open.2024; 12(08): E981. CrossRef
Endoscopic Retrograde Cholangiopancreatography Performed by Trainees Is Not Associated with Increased Immediate Adverse Events or Technical Failure Rates
Osayande Osagiede, Frank J. Lukens, Vivek Kumbhari, Juan E. Corral
Digestive Diseases and Sciences.2023; 68(5): 1747. CrossRef
Impact of center and endoscopist ERCP volume on ERCP outcomes: a systematic review and meta-analysis
Sara Teles de Campos, Apostolis Papaefthymiou, Theodosia Florou, Antonio Facciorusso, Marianna Arvanitakis, Jacques Devière, Paraskevas Gkolfakis
Gastrointestinal Endoscopy.2023; 98(3): 306. CrossRef
Unusual biliary gem: Cause of acute obstructive suppurative cholangitis and pancreatitis in a patient with Billroth II anastomosis
Koki Yamada, Susumu Shinoura
Annals of the Academy of Medicine, Singapore.2022; 51(3): 196. CrossRef
Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?
Shyam Vedantam, Sunil Amin, Ben Maher, Saqib Ahmad, Shanil Kadir, Saad Khalid Niaz, Mark Wright, Nadeem Tehami
Clinical Endoscopy.2022; 55(3): 426. CrossRef
Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: A systematic review
Zeinab Hassan, Eyad Gadour
World Journal of Gastroenterology.2022; 28(27): 3514. CrossRef
Experience of endoscopic retrograde cholangiopancreatography with side-viewing duodenoscope in patients with previous gastric surgery
Mehmet Emin Gürbüz, Dursun Özgür Karakaş
Turkish Journal of Surgery.2022; 38(2): 149. CrossRef
A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy
Orhan Coşkun, Bülent Ödemiş
Surgical Endoscopy.2021; 35(8): 4222. CrossRef
Efficacy and safety of the rotatable sphincterotome during ERCP in patients with prior Billroth II gastrectomy (with videos)
Feng Zhu, Yaping Guan, Jing Wang
Surgical Endoscopy.2021; 35(8): 4849. CrossRef
Experience of Endoscopists in Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy Patients
Chang-Hwan Park
Clinical Endoscopy.2020; 53(1): 7. CrossRef

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Ischemic Necrosis of the Gastric Remnant without Splenic Infarction Following Subtotal Gastrectomy: Hwan Hee Park, Hee Sung Lee, Ju Seok Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong, Ji Young Sul; Clin Endosc 2018;51(3):289-293. Published online August 24, 2017; DOI: https://doi.org/10.5946/ce.2017.099

Abstract PDF PubReader ePub

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.

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Gastric remnant necrosis after Roux-en-Y gastric bypass: an extremely rare and almost fatal complication: a case report
Darwin R Ramos, Antonio S Robalino, Daniel L Mogrovejo, Enrique Arias, Diana E Parrales, Miguel J Ochoa-Andrade, Gabriel A Molina
Journal of Surgical Case Reports.2025;[Epub] CrossRef
Gastric remnant necrosis secondary to cholesterol crystal embolization after distal gastrectomy in a gastric cancer patient: a case report
Jumpei Shibata, Motoi Yoshihara, Takehito Kato
BMC Surgery.2020;[Epub] CrossRef
Normal and Abnormal Postoperative Imaging Findings after Gastric Oncologic and Bariatric Surgery
Cheong-Il Shin, Se Hyung Kim
Korean Journal of Radiology.2020; 21(7): 793. CrossRef
Successful management of gastric remnant necrosis after proximal gastrectomy using a double elementary diet tube: a case report
Atsushi Gakuhara, Shuichi Fukuda, Tomoyuki Tsujimoto, Hideo Tomihara, Katsuya Ohta, Kotaro Kitani, Kazuhiko Hashimoto, Hajime Ishikawa, Jin-ichi Hida, Masao Yukawa
Surgical Case Reports.2020;[Epub] CrossRef
Necrosis of the Gastric Remnant after Distal Gastrectomy for Gastric Carcinoma—A Case Report—
Daisuke SHIRAI, Naoshi KUBO, Katsunobu SAKURAI, Yutaka TAMAMORI, Kiyoshi MAEDA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2019; 80(8): 1487. CrossRef

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Comparison of Endoscopic Submucosal Dissection and Surgery for Differentiated Type Early Gastric Cancer within the Expanded Criteria: Dong Woo Shin, Hee Young Hwang, Seong Woo Jeon; Clin Endosc 2017;50(2):170-178. Published online May 9, 2016; DOI: https://doi.org/10.5946/ce.2016.017

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic submucosal dissection (ESD) is a novel alternative treatment for differentiated early gastric cancer (EGC) without lymph node metastasis. We conducted this study to verify the therapeutic usefulness of ESD for treating differentiated EGC compared to that of surgery.
Methods
This is a retrospective cohort study of 382 patients treated with differentiated EGC from March 2006 to May 2010. The propensity score yielded 275 matched patients. They were divided into an ESD group of 175 people and a gastrectomy group of 100 people. The patient demographics, pathologic characteristics, length of hospital stay, complication rate and survival rate were compared.
Results
The complication rate was higher for the gastrectomy group than for the ESD group (15.0% vs. 5.1%, p=0.007). The average length of patient hospitalization was longer after gastrectomy than after ESD (8.6 days vs. 2.4 days, p<0.001). There were two cases of mortality in the surgery group within 30 days of procedure. The 5-year survival rates of the two groups did not show a statistically significant difference (92.0% vs. 93.3%, p=0.496).
Conclusions
The long-term survival rates of ESD and gastrectomy were not significantly different. The complication rate was lower for ESD than for gastrectomy, and the length of hospital stay was shorter after ESD than after gastrectomy.

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Journal of Gastric Cancer.2025; 25(1): 5. CrossRef
Long-term outcomes of additional surgery vs. observation after noncurative endoscopic submucosal dissection for early gastric cancer and application value of the eCura scoring system: a propensity score–matched study
Shangtao Mao, Wenjun Li, Yinya Pan, Hai Wu, Ying Xiang, Miao Liu, Tao Zhao, Hongji Tao, Lei Wang, Guifang Xu
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Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach
Tae-Han Kim, In-Ho Kim, Seung Joo Kang, Miyoung Choi, Baek-Hui Kim, Bang Wool Eom, Bum Jun Kim, Byung-Hoon Min, Chang In Choi, Cheol Min Shin, Chung Hyun Tae, Chung sik Gong, Dong Jin Kim, Arthur Eung-Hyuck Cho, Eun Jeong Gong, Geum Jong Song, Hyeon-Su Im
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Jae Yong Park, Mi-Sook Kim, Beom Jin Kim, Jae Gyu Kim
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Ana Clara Vasconcelos, Mário Dinis-Ribeiro, Diogo Libânio
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Mohammad A. Al-Haddad, Sherif E. Elhanafi, Nauzer Forbes, Nirav C. Thosani, Peter V. Draganov, Mohamed O. Othman, Eugene P. Ceppa, Vivek Kaul, Michael M. Feely, Ilyas Sahin, Yibing Ruan, Behnam Sadeghirad, Rebecca L. Morgan, James L. Buxbaum, Audrey H. Ca
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Nauzer Forbes, Sherif E. Elhanafi, Mohammad A. Al-Haddad, Nirav C. Thosani, Peter V. Draganov, Mohamed O. Othman, Eugene P. Ceppa, Vivek Kaul, Michael M. Feely, Ilyas Sahin, James L. Buxbaum, Audrey H. Calderwood, Jean M. Chalhoub, Nayantara Coelho-Prabhu
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Rajesh K. Singh
International Journal of Clinical Medical Research.2023; 1(3): 88. CrossRef
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Lanqing Cao, Zhaoyong Wang, Liwei Duan, Lijuan Wei
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Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy: Jong Soon Jang, Seungho Lee, Hee Seung Lee, Myeong Ho Yeon, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Sei Jin Youn, Seon Mee Park; Clin Endosc 2015;48(5):421-427. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.421

Abstract PDF PubReader ePub

Background/Aims

Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.

Methods

Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.

Results

Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.

Conclusions

Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

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A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Takuto Hikichi, Hiromasa Ohira
World Journal of Gastrointestinal Endoscopy.2020; 12(8): 220. CrossRef
Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
World Journal of Gastroenterology.2019; 25(24): 3091. CrossRef
Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article
Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
Journal of Digestive Diseases.2019; 20(12): 631. CrossRef
Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
Saudi Journal of Gastroenterology.2019; 25(6): 355. CrossRef
Endoscopic Management of Difficult Bile Duct Stones
Murad Aburajab, Kulwinder Dua
Current Gastroenterology Reports.2018;[Epub] CrossRef
Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis
Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
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Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients
Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
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Seon Mee Park
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A Large-Sized Phytobezoar Located on the Rare Site of the Gastrointestinal Tract: Jee Eun Yang, Ji Yong Ahn, Gi Ae Kim, Ga Hee Kim, Da Lim Yoon, Sung Jin Jeon, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2013;46(4):399-402. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.399

Abstract PDF PubReader ePub

Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 7×8 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion.

Citations

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Hervé Tshikomba Mbuyamba, Charles Oswald Ruboha, Aneth Gabriel Mhidze, Daudi Gervas Katwana, Mwanaisha Mohamed Mungia, Joel Zablon Nkika
International Journal of Surgery Case Reports.2025; 130: 111325. CrossRef
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Ana Fernanda Muñoz Durán, Juan Alberto Llanos Visbal, Leidy Vanessa Aguirre Carvajal, Juan Daniel Ayala Torres, Nicolás Álvarez Gärtner, Julián Andrés Muñoz Durán
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Kenta Katsumata, Takeharu Enomoto, Takehito Otsubo, Masaki Hiwatari, Yoshitsugu Tsukamoto, Natsuko Kamei, Jin Shimada, Shinjiro Kobayashi, Kazuhiro Ashikawa, Shinya Mikami
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Fatih Saygili, Erkin Oztas, Mahmut Yuksel, Yusuf Ozogul
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Obstructive Bezoars of the Small Bowel Treated with Coca-Cola Zero through a Long Intestinal Tube and Endoscopic Manipulation
Kei Endo, Keisuke Kakisaka, Yuji Suzuki, Takayuki Matsumoto, Yasuhiro Takikawa
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Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings
Lian-qin Kuang, Da-wei Zhao, Cheng Cheng, Yi Wang
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Usefulness of Forward-Viewing Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Billroth II Gastrectomy: Jong Won Byun, Jae Woo Kim, Se Yong Sung, Ho Yeon Jung, Hyo Keun Jeon, Hong Jun Park, Moon Young Kim, Hyun Soo Kim, Soon Koo Baik; Clin Endosc 2012;45(4):397-403. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.397

Abstract PDF PubReader ePub

Background/Aims

Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy.

Methods

A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients.

Results

The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury.

Conclusions

When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.

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A Case of Retrograde Jejunogastric Intussusception Following Subtotal Gastrectomy: Ji Hoon Yoon, M.D., Hyuk Yong Kwon, M.D., Myoung Joon Kim, M.D., Min Gu Chon, M.D., Seol Jung Ak, M.D., Seung Keun Park, M.D. and Hee Ug Park, M.D.; Korean J Gastrointest Endosc 2011;42(2):94-97. Published online February 28, 2011

Abstract PDF: Retrograde jejunogastric intussusception is a rare complication following Billroth ll gastric surgery. It is a segmental invagination of a jejunal loop into the stomach through stoma. Clinical manifestations are epigastric pain, vomiting with bile or blood, and a palpable mass in the epigastrium. Gastroscopy and a upper GI (UGI) series are very helpful in the diagnosis of this disease. Although the management of this disease is usually surgical, when endoscopic reduction has failed, surgery should be immediately done because of the high mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of Billroth ll surgery that had been done 6 years prior due to gastric cancer. (Korean J Gastrointest Endosc 2011;42:94-97)

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A Case of Signet Ring Cell Carcinoma with Hyperplastic Polyp in the Remnant Stomach after Subtotal Gastrectomy: Myung Hyun Lee, M.D., Woo Chul Chung, M.D., Sung Hoon Jung, M.D., Jae Wuk Kwak, M.D., Sung Jun Kim, M.D., Chang Nyol Paik, M.D. and Kang-Moon Lee, M.D.; Korean J Gastrointest Endosc 2010;40(5):325-328. Published online May 30, 2010

Abstract PDF: Hyperplastic polyps are usually found in the stomach and they account for 50 to 90% of all gastric epithelial polyps. In contrast to the adenomatous polyps, it has been reported that most hyperplastic polyps are benign. However, in rare cases hyperplastic polyps have revealed carcinoma, and the incidence of malignant changes is generally recognized to be about 1 to 3%. Most of the reported cases of a hyperplastic gastric polyp with a transformation to adenocarcinoma were well differentiated histopathologically. Herein we report on an extremely rare case that involved the association of a hyperplastic polyp and focal signet ring cell carcinoma in the remnant stomach after subtotoal gastrectomy. (Korean J Gastrointest Endosc 2010;40:325-328)

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A Case of Endoscopic Stenting for Anastomotic Leakage after Total Gastrectomy: Ja In Park, M.D., Jong Jae Park, M.D., Joo Yeon Oh, M.D., Won Woo Lee, M.D., Hye Jin Cho, M.D., Jae Young Moon, M.D., Jae Seon Kim, M.D. and Young Tae Bak, M.D.; Korean J Gastrointest Endosc 2009;39(6):369-373. Published online December 30, 2009

Abstract PDF: Anastomotic leakage after gastrectomy has significant morbidity and mortality, and the mortality rate has been reported to be over 60%. There have been very few reports concerning endoscopic stenting for the management of anastomotic leakage. Successful treatment of anastomotic leakage with covered self-expanding metallic stents (stent) has recently been reported. A 62-year-old man with melena was diagnosed with advanced gastric cancer and he underwent total gastrectomy. At the 3rd day after surgery, anastomotic leakage was found by an upper gastrointestinal series (UGI). He underwent laparoscopic primary repair on the 5th day after surgery. The leakage resumed thereafter. At the 12th day after the primary repair, the leakage was successfully managed by stent insertion and the patient improved thereafter. At the 11th week after stent insertion, the stent was removed without complications and the leakage was completely closed. At 1 year after stent removal, no stricture has been found on the anastomosis site. We report here on a case of anastomotic leakage after gastrectomy, and this was completely managed by stent insertion. (Korean J Gastrointest Endosc 2009;39:369-373)

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Incidence and Risk Factors of Reflux Esophagitis after a Subtotal Gastrectomy: Seung Joo Kang, M.D., Mi Na Kim, M.D., Su Hyun Kim, M.D., Jin Myung Park, M.D., Hyun Jin Jo, M.D., Mun Sun Choi, M.D., Sang Hyub Lee, M.D.*, Young Soo Park, M.D.*, Jin Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, D; Korean J Gastrointest Endosc 2008;37(4):243-252. Published online October 30, 2008

Abstract PDF: Background/Aims: The aims of this study were to evaluate the incidence of reflux esophagitis in patients after a subtotal gastrectomy and to determine risk factors for reflux esophagitis. Methods: Among 225 patients who underwent a subtotal gastrectomy from June 2003 to December 2004 at Seoul National University Bundang Hospital, 201 patients who received follow-up for more than six months and underwent at least one endoscpoic examination were retrospectively reviewed. We used the Los Angeles (LA) classification system and included a minimal change for reflux esophagitis. Results: There were 173 patients who underwent a Billroth I procedure and 28 patients who underwent a Billroth II procedure. The cumulative incidence of reflux esophagitis was 40.8%. A patient age ≥65 years (p=0.04), a follow-up duration ≥40 months (p=0.03), bile reflux gastritis (p＜0.01) and postoperative obesity (p=0.02) were significant risk factors for the development of reflux esophagitis including a minimal change. The number of postoperative endoscopies ≥4 (p=0.012), bile reflux gastritis (p=0.002) and postoperative obesity (p=0.038) were risk factors for a minimal change. A patient age ≥65 years (p=0.04), a follow-up duration ≥40 months (p=0.03) and Helicobacter pylori eradication before surgery (p＜0.01) were independent risk factors for LA grade A/B reflux esophagitis. Conclusions: Bile reflux gastritis is a risk factor for the development of reflux esophagitis after a subtotal gastrectomy. Preoperative helicobacter eradication is also associated with reflux esophagitis, except for a minimal change, but further studies are needed. (Korean J Gastrointest Endosc 2008;37:243-252)

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A Case of Retrograde Jejunogastric Intussusception Diagnosed by Gastroscopy: Hyeug Lee, M.D., Eun Ok Kim, M.D., Juyoung Shin, M.D., Seung Hyun Oh, M.D., Hong Seok Song, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Jeong Jo Jeong, M.D., Sang Wook Choi, M.D., Sung Geun Kim, M.D.*, Sang Seob Yun, M.D.* and Seong Lee, M.D.*; Korean J Gastrointest Endosc 2008;37(2):112-115. Published online August 30, 2008

Abstract PDF: Retrograde intussusception of the jejunum into the stomach through the stroma of a gastroenterostomy is a very rare, but potentially fatal complication after gastrectomy. Once symptoms develop, the mortality rate is high if this is not treated within 48 hours, so making an early diagnosis with a high index of suspicion and administering prompt treatment are mandatory. Gastroscopy could be a useful diagnostic tool for patients with a history of gastrectomy and who present with abdominal pain and hematemesis, and with considering the possibility of intussusception. A 65-year-old man with a history of Billroth II gastrectomy that was done 35 years ago due to gastric ulcer perforation was admitted with abdominal pain and hematemesis. A necrotic mucosa that was suspicious of an intussuscepted small bowel tissue was detected on gastroscopy. Subsequent open reduction and small bowel resection was performed with successful results. We report here on a case of postoperative retrograde jejunogastric intussusception that occurred 35 years after Billroth II gastrectomy, and it was first diagnosed by performing gastroscopy. (Korean J Gastrointest Endosc 2008;37:112-115)

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A Case of Jejunogastric Intussusception that was Diagnosed by Gastroscopy in a Patient who had Undergone Subtotal Gastrectomy: Kang Kim, M.D., Gun Young Hong, M.D., Sang Chul Choi, M.D., Jun Ho Cho, M.D., Kyung Rok Lee, M.D., Sang Uk Park, M.D., Kang Suk Seo, M.D. and Yun Ken Lym, M.D.; Korean J Gastrointest Endosc 2008;37(1):25-29. Published online July 30, 2008

Abstract PDF: Jejunogastric intussusception is a rare, but potentially lethal complication after gastrectomy or gastrojejunostomy. In the acute condition, early diagnosis and prompt surgical treatment are mandatory to reduce the incidence of mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of subtotal gastrectomy, and she had experienced increasing epigastric pain and vomiting for 1 day. (Korean J Gastrointest Endosc 2008;37:25-29)

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A Case of a Primary Esophageal Bezoar after a Total Gastrectomy: Hwa Mock Lee, M.D., Won Il Park, M.D., Hyun Ju Kim, M.D., Sung Han Yun, M.D., Nam Sik Kim, M.D., Seung Eun Lee, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Joon Seok Oh, M.D., Jong Yun Cheong, M.D., Won Ook Ko, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2008;36(2):71-73. Published online February 27, 2008

Abstract PDF: An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications. (Korean J Gastrointest Endosc 2008;36:71-73)

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Case Series of ERCP and EST with Rotatable Papillotome (Autotome^Ⓡ) in Patients with Billoth II Gastrectomy: Yong Hun Kim, M.D., Chang-Il Kwon, M.D., Dae Young Kim, M.D., Myung Su Son, M.D., Kwang Hyun Ko, M.D., Sung Pyo Hong, M.D., Seong Gyu Hwang, M.D., Pil Won Park, M.D. and Kyu Sung Rim, M.D.; Korean J Gastrointest Endosc 2007;35(6):445-450. Published online December 30, 2007

Abstract PDF: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) are the mainstays of the diagnosis and treatment of variable hepatobiliary and pancreatic diseases. The success rate of ERCP and EST in patients who have undergone a Billroth II gastrectomy is lower than in patients with a normal anatomy. Because the view of the ampulla is rotated 180^o in patients with Billroth II, several methods (ex, precut biliary needle-knife papillotome or wire-guided billroth II papillotome) have been used for endoscopic sphincterotomy instead of a pull-type papillotome. Using the recently devised pull-type and rotatable papillotome (Autotome^Ⱂ), we performed successful ERCP and EST in 2 patients with a Billroth II gastrectomy without complications. (Korean J Gastrointest Endosc 2007;35:445-450)

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The Eradication Rate of Helicobacter pylori on the Remnant Stomach after Curative Resection for Gastric Cancer and the Influence of Eradication: In Kyoung Kim, M.D., Woo Hyun Paik, M.D., Jae Kyung Lee, M.D., Goh Eun Chung, M.D., Youn Joo Kim, M.D., Chang Hyun Lee, M.D., Kyoung Sup Hong, M.D., Sang Hyub Lee, M.D.*, Young-Soo Park, M.D.*, Jin-Hyeok Hwang, M.D.*, Jin-Wook Kim, M.D.*, Sook Hyang Jung,; Korean J Gastrointest Endosc 2007;35(4):216-220. Published online October 30, 2007

Abstract PDF: Background
/Aims: There are few reports on the rate of H. pylori eradication and the influence of this eradication in the remnant stomach after a curative resection for a gastric carcinoma. Methods: The medical records of patients who had undergone curative gastrectomy for carcinoma between May, 2003 and June, 2006 were reviewed to evaluate the serial H. pylori status. The eradication regimen was a proton pump inhibitor (PPI) based triple therapy (PPI, amoxicillin, clarithromycin). After eradication, the histological changes were reviewed based on the updated Sidney system. In addition, a CLO test and urea breath test were used for the evaluation. Results: Eighty five patients were found to be positive for a H. pylori infection after the curative gastrectomy. Fifty two patients received eradication therapy and the other 33 patients did not. The eradication rate in patients who received therapy was 82.7% and spontaneous resolution rate in the patients who did not receive therapy was 78.8% (p=0.654). After eradication, the remnant stomach showed a significant decrease in the inflammation and activity scores. Conclusions: The eradication rate of H. pylori by PPI based triple therapy in the remnant stomach is similar to that in a non-surgical stomach. The decrease in the inflammation and activity score suggests that the eradication may prevent H. pylori related carcinogenesis. However, the high spontaneous negative conversion rate (78.8%) in the remnant stomach after gastrectomy will require further study. (Korean J Gastrointest Endosc 2007;35:216-220)

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Two Cases of Intussusception Occurring through the Stoma after Gastric Surgery: Sung-Jo Bang, M.D., Do Ha Kim, M.D., Gin Hyug Lee, M.D.*, Jeong-Sik Byeon, M.D.*,; Korean J Gastrointest Endosc 2004;28(4):183-187. Published online April 30, 2004

Abstract PDF: Intussusception is a rare but potentially serious complication of gastric surgery, and 6
case
s have been reported in Korea. Diagnosis can be made by endoscopy, upper gastrointestinal series or computed tomography, but it needs a high index of suspicion for diagnosis. Early diagnosis and prompt surgical intervention is mandatory to avoid mortality. We report two cases of intussusception occurring through the stoma after gastric surgery. A 58-year-old woman presented with epigastric pain and vomiting followed by hematemesis, 30 years after gastrojejunostomy for pyloric obstruction caused by duodenal ulcer. Endoscopy showed jejunogastric intussusception and CT scan was compatible with the diagnosis. She was managed by segmental resection and anastomosis of the jejunum. Another 60-year-old man presented with epigastric pain and hematemesis, 7 years after total gastrectomy with a Roux-en-Y anastomosis for advanced gastric cancer. He was diagnosed as having chronic type jejunal intussusception by endoscopy and CT scan, and intussusception was resolved spontaneously. (Korean J Gastrointest Endosc 2004;28: 183 ⁣187)

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위수술 후 수술 문합부에 발생한 장중첩증 2예: Korean J Gastrointest Endosc 2003;27(5):459-459. Published online November 20, 2003

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수술 기왕력이 대장내시경 삽입에 미치는 영향: Korean J Gastrointest Endosc 2003;27(5):365-365. Published online November 20, 2003

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위절제 후의 역류성 위염에서 helicobacter pylori 감염의 영향 ( Effect of Helicobacter pylori Infection on Reflux Gastritis after Gastrectomy ): Korean J Gastrointest Endosc 2001;23(3):149-154. Published online November 30, 2000

Abstract PDF: Background
/Aims: Reflux gastritis after gastrectomy is believed to be due to reflux of bile into residual stomach. However the substances that cause gastritis have not yet been precisely defined. Helicobacter pylori (H. pylori) infection is considered one of the most important pathogenetic factors in gastritis. The prevalence of H. pylori infection and the role of its infection on reflux gastritis after gastrectomy were investigated. Methods: Eighty-one patients who had undergone subtotal gastrectomy were enrolled. Rapid urease test and histologic examinatin for H. pylori infection were perrormed during gastrofiberacopy. An eradication of H. pylori was attempted in fifteen H. pyori-positive patients who suffered from gastritis symptoms after gastrectomy. Follow-up endoscopy was performed more than 4 weeks afrtr the end of eradication treatment. Results: Forty-nine patients (60.5%) demonstrated H. pylori infection in their residual stomach. The histological gastritis score in patients with H. pylori infection was significantly higher than that without infection. Ten of the 15 patients (66.7%) with H. pylori infection had their infection successfully eradicated. And also their symptoms and histological gastritis score were significantly improved. Conclusions: H. pylori infection does play an important role on reflux gastritis after subtotal gastrectomy. (Korean J Gastrointest Endosc 2001;23:149-154)

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담도 배액관 유도 유두부 절개술 - 난해한 유두부주위 게실 및 위 부분절제술 환자에서 - ( A Stent-Guided Sphincterotomy in Patients with a Difficult Periampullary Diverticulum or with a Billroth-II Gastrectomy ): Korean J Gastrointest Endosc 2000;20(1):26-32. Published online November 30, 1999

Abstract PDF: Background
/Aims: Patients with a congenitally or surgically altered anatomy such as a large diverticulum in which an ampullary orifice exists or a Billroth-II gastrectomy, have an increased complication rate after endoscopic sphincterotomy (EST) compared to normal anatomies. An experience involving a stent-guided sphincterotomy using an endoprosthesis is herein reported. Methods: 10 patients with a Billroth-II gastrectomy and 9 patients with a large diverticulum received a stent-guided EST. In the diverticula cases, all the ampullary orifices were located either inside the diverticulum or in an unusual position. All patients had common bile duct stones and symptoms of cholangitis. After a 0.035 inch guide wire was inserted through the side-viewing duodenoscope, a 10 Fr. endoprosthesis (MTW, Germany) was inserted and a needle-knife sphincterotome was introduced. In patients with a Billroth-II anatomy, the incision was made from the papillary orifice of the 12 o'clock position toward 6 o'clock. In patients with periampullary diverticula, the incision was made with sweeps of the needle-knife in a 6 to 12 o'clock direction. The cautery current was applied to the mucosa along the stent and the stent was retrieved by a polypectomy snare through the biopsy channel without removal of an endoscope. Results: Among the 19 patients, the guide wire and stent insertion were possible in all except one patient due to the inability of selective cannulation. An EST was performed in all patients after stent insertion. There were no serious complications during and after the stent-guided EST except for two minor bleedings which were treated with a coagulation current using the needle-knife. Consequently, complete endoscopic stone removal was achieved in all patients including three patients in whom a mechanical lithotriptor was needed. Conclusions: In stent-guided EST, the stent not only guides the adequate direction of the incision but also allows a controlled incision under a favorable visual field. Therefore, blind cutting and exploration during EST can be avoided and successful EST is possible even in difficult situations such as that created by an altered anatomy. (Korean J Gastrointest Endosc 2000;20:26~32)

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다발성으로 발생한 십이지장 유암종 1 예 ( A Case of Multicentric Duodenal Carcinoid ): Korean J Gastrointest Endosc 1999;19(1):93-97. Published online November 30, 1998

Abstract PDF: Carcinoid tumors are the most common endocrine tumors of gastrointestinal tract. Argentaffin cells are the origin of carcinoids. These cells belong to the amino precursor uptake and decarboxylation (APUD) system. These cells give the tumor its most distinguishing feature: the ability to produce biogenic amines and polypeptide hormones that, in turn, give rise to the dramatic carcinoid syndrome. We treated a case of multi-centric carcinoid tumor of the duodenum in a 63-year-old male patient. He was admitted to the hospital because of epigastric pain. On the gastrofiberscopic examination, 1.0 ×1.5 cm and 0.7 ×0.8 cm sized two polyps (Yamada type II, I) were noticed on the duodenal bulb. The biopsy specimen showed carcinoid tumors of different histologic types. The level of 24-hour urine 5-HIAA of this case was normal. He was treated with subtotal gastrectomy with Billroth-II anastomosis. We report this case with literature review. (Korean J Gastrointest Endosc 19: 93 ∼97, 1999)

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원저 : 식도 위장관 ; 위절제술 후 발생한 내시경적 역류성 위염 및 식도염 - 임상적 의미와 술식에 따른 차이 - ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Alkaline Reflux Gasitritis and Esophagitis in Gastroresected Patients ): Korean J Gastrointest Endosc 1997;17(6):743-749. Published online November 30, 1996

Abstract PDF: Background
/Aims: The reflux alkaline gastritis and esophagitis are important late complications after gastric surgery. Endoscopy is primary diagnostic tool for them. But, the clinical significance of gastritis and esophagitis diagnosed by endoscopy is not well known. We evaluated the correlation between the alkaline reflux gastritis and esophagitis and their symptoms and we also examined their prevalence according to types of surgery. Methods: The 111 gastroresected patients who had had upper endoscopy by one endoscopist were evaluated. We reviewed all their medical records, and interviewed 54 patients by telephone to evaluate symptoms. Results: Endoscopic reflux alkaline gastritis was observed in 38 patients(45%) with Billroth- II gastrectomy and in 4 patients(33%) with Bil]roth- I gastrectomy. But, there was no symptomatic difference between group with and without endoscopic reflux gastritis. Moreover, none of them had typical reflux gastritis symptom complex including billous vomiting. In all patients with total gastrectomy and loop esophagojejunostomy, endoscopic reflux esophagitis was observed. But, there was no case af endoscopic reflux esophagitis in the patients with total gastrectomy and Roux-en-Y anastomosis. There was significant symptomatic correlation between group with and without endoscopic reflux esophagitis. T'he incidence of reflux esophagitis had no difference between Billroth- II gastrectomy and Billroth- I gastrectomy. Conclusion: The endoscopic alkaline reflux gastritis had poor symptematic correlation. In the case of total gastrectomy, for the prevention of reflux esophagitis, Roux-en-Y anastomosis is better than loop esophagojejunostomy. (Korean J Gastrointest Endosc 17: 743-749, 1997)

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증례 : 식도 위장관 ; 조기위암 수술 후 문합부에 발생한 원발성 위방선균증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Actinomycosia after Gastrectomy for Early Gastric Cancer ): Korean J Gastrointest Endosc 1996;16(5):757-760. Published online November 30, 1995

Abstract PDF: Primary gastric actinomycosis is an extremely rare disease and less than 20 cases are reported in literature. We experienced a case of gastric actinomycosis in the 63-year-old woman who had subtotal gastrectomy for early gastric cancer(type IIc) 7 month ago. Endoscopic biopsy from elevated lesion on stoma was found to show the neutrophilic infiltration and sulfur granule. She placed on tetracycline for 30 days. Follow up endoscopy showed no abnormality. We report this case with literature review. (Koresn J Gastrointest Endosc 18: 757~ 760, 1996)

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Billroth-Ⅱ 위절제술 환자에서 치료 내시경적 역행성 담관췌관조영술 ( Therapeutic Endoscopic Retrograde Cholangiography in Patients with a Billroth Ⅱ Gastrectomy - 2 cases of ERBD & 1 case of endoscopic stone retrievial - ): Korean J Gastrointest Endosc 1992;12(2):271-277. Published online November 30, 1991

Abstract PDF: Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone partial gastrectomy with Billroth II anastomosis. Because its altered anatomical relationship. the endoscopist is presented with additional problems: (i) Dfficulties in entering the afferent loop, depending on the surgical techiques used. (ii) The endoscope may be too sort to reach the papillary region unless the loops are suecessfully straightened out. (iii) Difficulties in passing the ligament of Treitz, especially in patients with Braun's anastomosis, (iv) Problems in cannulating the papilla and especially the common bile duct from a reversed position. (v) Problems in carrying out a papillotomy in a correct position. We attempted endoscopic sphincterotomy in 3 opatients previously subjected to gastrectomy with needle knife, and succeeded in 2 of them. In the two patients, successful billary drainage was achieved. And one patients with Billroth II gastrectomy, presented with CBD stone and cholangit, was successfully treated with endoscopic stone retriveial. The patient with a Billroth-II operation may unergo endscopic diagnostic as well as thera peutic procedures with a high rate of success, and can be suitable candidates for ERCP and endoscopic sphincterotomy

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위절제술후 십이지장-위 역류성 위염 ( Reflux Gastritis after Gastrectomy ): Korean J Gastrointest Endosc 1990;10(1):41-45. Published online November 30, 1989

Abstract PDF: We studied prospectively on the grade of severity of reflux gastritis after Billroth- I (15 patients and B-II (66 patients) using gastrofiberscopy mostly 3~4 montsh after operations from December 1988 to February.The grade of severity af gastritis was arbitarily defined as follows; Grade 0-almost no reflux of bile and no redness on gastric mucosa. Grade 1-mild redness of the mucosa limited within an inch from anastomotic line. Giade 2-Edema and mucosal redness involves almost one half of remaining gastric mucosa. Grade 3-the above cbanges involves most of remnant gastric mucosa. Gtade 4-in addition to grade 3, friability of mucosa and/or, erosions is noted. Grade 5- ulceraitions of mucosa in addition to the above changes. Using the above defined criteria, we obtained the following results; 1) there was no rieflux gastritis in one patient in B- I group and remainders have varing grades of reflux gastritis, ie; 93% (14/15) (see Table 2). 2) In B- II reconstructed patients, grade 0 was 2 patients and remainder had reflux gastrits, ie; 96% (64/66) (see table 4). 3) Grade 5 patients have ulcerations in the esophagus and grade 2 changes in the stomach.

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