Jejunal interposition following proximal gastrectomy for early gastric cancer : effect on the quality of life

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Background: Early gastric cancer arising in the upper third area (U-area) has increased in incidence, but the operative outcome and prognosis have improved. However, a standard reconstruction procedure has not been established. The aim of this study was to investigate the usefulness of jejunal interposition for reconstruction after proximal gastrectomy following with a modification for prevention gastro-esophageal reflux. Methods: The subjects were 9 patients with mucosal or submucosal gastric cancer in U-area, in whom jejunal interposition was performed for reconstruction after proximal gastrectomy. The control group was 8 patients with mucosal or submucosal gastric cancer and leiomyoma in whom esophagogastrostomy was performed. Results: After jejunal interposition, there were no symptoms of esophageal reflux such as heartburn and regurgitation, and no esophagitis was seen on endoscopic examination. Furthermore, reflux of gastric contents into the esophagus was not seen on either upper gastrointestinal series or scintigraphy. After esophagogastrostomy, however, esophageal reflux symptoms and endoscopic evidence of esophagitis due to reflux were noted in 7 out of 8 patients (87.5%), and medications were needed for symptomatic relief. Conclusions: Jejunal interposition following with a modification for prevention of gastro-esophageal reflux may be an excellent procedure for improving the postoperative quality of life after proximal gastrectomy.

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