Clinical Endoscopy

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

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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Remnant Gastric Necrosis after Laparoscopic Distal Gastrectomy Managed with Double-Elemental Diet Tube and Laparoscopic Gastrojejunostomy: A Case Report
Kazuki Sameshima, Takaaki Arigami, Daisuke Matsushita, Masataka Shimonosono, Hiroshi Okumura, Keishi Okubo, Masahiro Noda, Ken Sasaki, Kenji Baba, Takao Ohtsuka
Surgical Case Reports.2026; 12(1): n/a. CrossRef
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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
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Jumpei Shibata, Motoi Yoshihara, Takehito Kato
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Cheong-Il Shin, Se Hyung Kim
Korean Journal of Radiology.2020; 21(7): 793. CrossRef
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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
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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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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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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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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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