Reflux esophagitis after total gastrectomy with jejunal pouch reconstruction: comparison of long and short pouches

Abstract

Objective: To evaluate the effect of the type of jejunal pouch (long or short) on reflux esophagitis after total gastrectomy.

Methods: Two groups of patients who underwent jejunal pouch reconstruction (long pouch, n = 9; short pouch, n = 9) after total gastrectomy were compared, and each was also compared with a group of healthy control subjects (n = 9). Reflux symptoms were assessed using a reflux score questionnaire derived from Moran's graded reflux questionnaire. Scintigraphy was performed to evaluate quantitatively intestinoesophageal reflux and pouch emptying time (t75%).

Results: Heartburn was more common in the long pouch group than in the short pouch group (56 vs 11%, p < 0.05), and the reflux score was significantly higher in the long pouch group (mean score 3.0 vs 1.0, p < 0.01). The scintigraphic reflux index in the long pouch group, short pouch group, and control group was 9.57 +/- 5.52, 7.05 +/- 3.35, and 1.55 +/- 0.70, respectively. The reflux index in the entire group of patients was significantly higher than that in the control group (p < 0.005). In addition, t75% was significantly longer in the long pouch group (46.0 +/- 16.2 min) than in the short pouch group (21.1 +/- 15.39 min).

Conclusion: Our findings suggest that reconstruction with a short jejunal pouch is more effective than a long pouch in preventing reflux symptoms.