Prognostic value and potential mechanism for the role of SNHG4 in gastric cancer / 中华内分泌外科杂志

Objective:To investigate the expression, prognostic value and potential mechanism for the role of SNHG4 in gastric cancer.Methods:The expression of SNHG4 in gastric cancer was analyzed by UALCAN database. The relationship between SNHG4 and prognosis of gastric cancer was analyzed by Kaplan-Meier Plotter. SNHG4-miRNA-mRNA regulatory network was constructed by StarBase, Targetscan, microT-CDS and Cytoscape. The target genes were analysis GO and KEGG pathway enrichment by DAVID database.Results:The expression of SNHG4 in gastric cancer was significantly higher than that in normal tissues ( P=8.882E-16) . The overall survival time of patients with high SNHG4 expression was lower than that of patients with low expression ( P=8.900E-05) . Through the construction of RNA regulatory network, we found that hsa-let-7a-5p ( P=1.02E-03) , hsa-miR-152-3p ( P=4.51E-06) , hsa-miR-204-5p ( P=6.68E-04) and hsa-miR-363-3p ( P=8.06E-03) could be used as the binding sites of SNHG4 in gastric cancer, and these four miRNAs further regulated 250 downstream target genes. Through GO and KEGG enrichment analysis of the target genes, we found that these target genes played roles in the biological process of protein phosphorylation regulation, transcription negative regulation, RNA polymerase II promoter transcription, and participated in the occurrence and development of gastric cancer by blocking or activating Wnt and other signal pathways. Conclusions:SNHG4 can be used as a potential tumor marker for gastric cancer to judge the prognosis of gastric cancer. By constructing a SNHG4-miRNA-mRNA regulatory network, the pathogenesis of gastric cancer can be studied at the molecular level. This provides a clear direction for experimental and clinical research.

Results of surgical treatment of advanced gastric cancer: case series with follow-up / Resultados del tratamiento quirúrgico del cáncer gástrico avanzado: serie de casos con seguimiento

SUMMARY: Gastric cancer (CG) is the second leading cause of cancer deaths. The best treatment option for patients with advanced GC (AGC) is still surgery, which involves performing a gastrectomy and D2 lymphadenectomy (D2L). The aim of this study was to determine postoperative morbidity (POM) and 5-year OS in patients resected by AGC without neoadjuvant. Case series with follow-up of patients with AGC undergoing total or subtotal gastrectomies and D2L, consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2019. The outcome variables were POM and 5-year OS. Other variables of interest were surgical time, number of resected lymph nodes, hospital stay, and recurrence. Descriptive statistics was used, and Kaplan-Meier curves were calculated. In this analysis 38 patients (71.1 % men), with a median age of 65 years, were operated. The most frequent location was subcardial (50.0 %). The most frequent type of resection was total gastrectomy (60.5 %). The median of surgical time, number of resected lymph nodes and hospital stay; was 190 min, 32 and 6 days respectively. MPO was 18.4 %. With a median follow-up of 28 months, a recurrence of 44.7 % was verified; and 5-year OS for stages IIIA, IIIB and IV were 53.3 %, 46.1 % and 20.0 % respectively (p= 0,007). The results achieved, in terms of POM and OS series were similar to national and international series in which neoadjuvant therapies have not been applied.

RESUMEN: El cáncer gástrico (CG) es la segunda causa de muerte por cáncer. La mejor opción terapéutica para pacientes con CG avanzado (CGA), sigue siendo la cirugía, que supone la realización de gastrectomía asociada a linfadenectomía D2 (LD2). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia (SV) en pacientes resecados por CGA sin neoadyuvancia. Serie de casos con seguimiento, de pacientes con CGA sometidos a gastrectomía total o subtotal con LD2, de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2008 y 2019. Las variables resultado fueron MPO y SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria y recurrencia. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 38 pacientes (71,1 % hombres), con una mediana de edad de 65 años. La localización más frecuente fue subcardial (50,0 %); el tipo de resección más frecuente fue gastrectomía total (60,5 %). Las medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fue 190 min, 32 y 6 días respectivamente. La MPO fue 18,4 %. Con una mediana de seguimiento de 28 meses, se verificó recurrencia de 44,7 %; y SVAG a 5 años para estadios IIIA, IIIB y IV de 53,3%, 46,1 % y 20,0 % respectivamente (p=0,007). Los resultados obtenidos, en términos de MPO, mortalidad y SVAG, fueron similares a series de centros de derivación nacionales e internacionales en los que no se ha aplicado terapias neoadyuvantes.

Cáncer gástrico avanzado: resultados de una cirugía resectiva en un centro privado y regional de salud / Advanced gastric cancer: resective surgery results in a private and regional health establishment

El cáncer gástrico (CG), representa el cuarto lugar de enfermedades oncológicas en mujeres y el primero en hombres. La mejor opción de tratamiento para pacientes con CG avanzado (CGA), sigue siendo la cirugía, lo que supone la realización de una gastrectomía total o subtotal, asociado a linfadenectomía D2 (LD2 ). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia (SV) en pacientes resecados por CGA sin neoadyuvancia. La metodología usada fue serie de casos en retrospectiva de pacientes con CGA sometidos a gastrectomía total o subtotal con LD2 , de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2008 y 2017. La variable resultado fue SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria, MPO, y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier y long Rank test. Se intervinieron 29 pacientes (72,4 % hombres), con una mediana de edad de 63 años. La localización más frecuente fue subcardial (51,7 %); el tipo de resección más frecuente fue gastrectomía total (51,7 %). La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fue de 185 min, 32 y 6 días respectivamente. La MPO fue 17,2 %. Con una mediana de seguimiento de 26 meses, se verificó recurrencia de 37,9 %; y SVAG a 5 años para estadios IIIA, IIIB y IV fue de 47,6 %, 34,3 % y 15,4 % respectivamente (p < 0,05). Los resultados obtenidos, en términos de MPO, mortalidad y SVAG, fueron similares a series de centros de derivación nacionales e internacionales en los que no se ha aplicado terapias neoadyuvantes.

Gastric cancer (CG) represents the fourth place of oncological diseases in women and the first in men. The best treatment option for patients with advanced CG (ACG) is still surgery, which involves making total or subtotal gastrectomies and D2 lymphadenectomy (D2L). The aim of this study is to determine postoperative morbidity (POM) and overall survival (OS) in patients resected by CGA without neoadjuvant therapy. The methodology used was a series of cases in retrospective of patients with CGA undergoing total or subtotal gastrectomies and D2L, consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2017. The outcome variable was OS at 5 years. Other variables of interest were: surgical time, number of resected lymph nodes, hospital stay, POM, and recurrence. Patients were followed clinically. Descriptive statistics was used, and OS analysis was applied using long Rank test. Twenty-nine patients (72.4% men), with a median age of 63 years, were operated. The most frequent location was subcardinal (51.7%). The most frequent type of resection was total gastrectomy (51.7%). The median of surgical time, number of resected lymph nodes and hospital stay; was 185 min, 32 and 6 days respectively. MPO was 17.2%. With a median follow-up of 26 months, a recurrence of 37.9% was verified; and 5-year OS for stages IIIA, IIIB and IV were 47.6%, 34.3% and 15.4% respectively (p <0.05). The results achieved, in terms of POM and OS series were similar to national and international series in which neoadjuvant therapies have not been applied.

Resultados de la cirugía resectiva de pacientes con Cáncer de Colon no complicado en un centro privado y regional de salud / Results of resective surgery in patients with non-complicated Colon Cancer in a private and regional health establishment

El tratamiento estándar del cáncer de colon (CC), continúa siendo la resección radical del segmento intestinal comprometido con márgenes libres (al menos 5 cm por encima y debajo del tumor), pudiendo o no asociarse a terapias complementarias. El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia actuarial global (SVAG) a 5 años en pacientes resecados por CC no complicado. La metodología usada fue serie de casos retrospectiva de pacientes con CC no complicado, sometidos a colectomía subtotal y linfadenectomía, de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2007 y 2017. La variable resultado fue SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria, MPO, y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 43 pacientes (58,1 % hombres), con una mediana de edad de 66 años. La localización y estadios más frecuentes fueron colon derecho (18 casos, 41,9 %); y IIIA, IIIB, respectivamente. La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fueron de 100 minutos, 30 y 5 días, respectivamente. La MPO fue 30,2 % (13 casos). Con una mediana de seguimiento de 55 meses, se verificó una recurrencia de 13,9 %; y SVAG a 5 años de 69,8 % para la totalidad de la serie. Los resultados obtenidos, en términos de MPO, mortalidad y SVAG a 5 años, fueron similares a series de nacionales e internacionales.

The standard treatment of colonic cancer (CC) continues to be the radical resection of the intestinal segment compromised with free margins, associated or not with adjuvant therapies. The aim of this study was to determine postoperative morbidity (POM) and 5-year overall survival (OS) in patients resected by non-complicated CC. The methodology used was a series of cases in retrospective of patients with non-complicated CC undergoing colectomy and lymphadenectomy, consecutively, at RedSalud Mayor Temuco Clinic, between 2007 and 2017. The outcome variable was 5-years OS. Other variables of interest were: surgical time, the number of resected lymph nodes, hospital stay, POM, and recurrence. Patients were followed clinically. Descriptive statistics were used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves. 43 patients (58.1% men) were intervened, with a median age of 66 years. The most frequent localization and stages were the right colon (18 cases, 41.9%); and IIIA, IIIB respectively. Median surgical time, the number of resected lymph nodes and hospital stay were 100 min, 30 and 5 days respectively. MPO was 30.2% (13 cases). With a median follow-up of 55 months, a recurrence of 13.9% was verified, and a 5-year OS of 69.8% was observed. The results, in terms of POM, mortality and 5-year OS, were similar to the national and international series.

Current status and application of endoscopic submucosal dissection for early gastric cancer / 中国肿瘤临床

Owing to technological developments in endoscopic treatment with continued development and application of newer en-doscopic equipment, as well as improved health consciousness among patients, a greater number of patients are being diagnosed with early gastric cancer (EGC). Both laparotomy and laparoscopic surgery can achieve satisfactory results in the treatment of EGC. Pa-tients undergoing endoscopic treatment for EGC showed improved quality of life postoperatively with lower complication rates. Endo-scopic submucosal dissection (ESD) is being widely used to treat EGC, with an overall 5-year survival rate of 90%. Patients undergoing ESD showed better perioperative outcomes in terms of lesser physical trauma, higher safety, excellent patient compliance, and lower treatment costs. ESD may gradually replace conventional surgery as the primary treatment for EGC. This paper focuses on the clinical application of ESD in the management of EGC.

Treatment Strategies after Non-curative Endoscopic Resection of Early Gastric Cancer / 대한소화기학회지

The cases of non-curative endoscopic resection (NCR) of early gastric cancer have increased due to the widespread use of endoscopic submucosal dissection (ESD). NCR is associated with augmenting chances of local recurrence and lymph node metastasis (LNM). Therefore, some additional treatment strategies after NCR are needed. Treatment strategies for NCR should be determined by considering the risk of residual tumor or local recurrence and LNM. Additional surgical treatment such as gastrectomy and lymph node dissection are recommended in patients who have high-risk of LNM. Close observation without additional treatment is considered for selected patients with a less possibility of local recurrence or LNM. Also it may be suggested if there is no or less benefit from surgery in elderly patients or patients with underlying diseases. Additional endoscopic procedures including ESD, endoscopic mucosal resection or argon coagulation therapy are suggested alternatively for highly selected patients not at risk of LNM based on the absolute or expanded criteria of ESD.

Cáncer gástrico avanzado: resultados observados en un centro regional privado de salud / Advanced gastric cancer: results observed in a private regional health center

El cáncer gástrico (CG), representa el cuarto lugar de enfermedades oncológicas en mujeres y el primero en hombres. Para el CG avanzado (CGA), la cirugía continua siendo el tratamiento de elección, lo que implica la realización de gastrectomías y linfadenectomía D2 (LD2). El objetivo de este estudio es determinar morbilidad postoperatoria (MPO), mortalidad, supervivencia (SV) y recurrencia, en pacientes resecados por CGA. Serie de casos retrospectiva de pacientes con CGA sometidos a gastrectomía y LD2, de forma consecutiva; en Clínica Mayor de Temuco, entre 2008 y 2014. La variable resultado fue supervivencia SV actuarial global a 5 años (SVGA5). Otras variables de interés fueron: MPO, mortalidad y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión. Se intervinieron 22 pacientes (68,2 % hombres), con una mediana de edad de 61 años. La localización más frecuente fue subcardial (45,5 %); el tipo de resección más frecuente fue gastrectomía total (54,5 %). La medianas del tiempo quirúrgico, resección de linfonodos y estancia hospitalaria; fue de 155 min, 24 y 6 días respectivamente. La MPO fue 18,2 %. Con una mediana de seguimiento de 22,5 meses, se verificó una SVGA5 de 37 %; y una recurrencia de 36,4 %. Los resultados obtenidos, en términos de MPO, mortalidad y SVGA5, son comparables a series de centros de derivación nacionales e internacionales en los que no se ha aplicado terapias neoadyuvantes.

Gastric cancer (GC) is the fourth of oncological diseases in women and the first men. For advanced GC (AGC), surgery remains the treatment of choice, which involves performing gastrectomies and D2 lymphadenectomy. The aim of this study is to determine postoperative morbidity (POM), mortality, survival (SV) and recurrence in patients resected by AGC. Retrospective case series of patients with AGC undergoing gastrectomies and LD2, consecutively at the Clínica Mayor in Temuco, between the years 2008 and 2014. The outcome variable was SV. Other variables of interest were: POM, mortality and recurrence. Patients were followed clinically. Descriptive statistics were used, with measures of central tendency and dispersion. Twenty- two patients (68.2 percent male) were operated, with a median age of 61 years. The most frequent location was subcardial (45.5 percent); the most common type of resection was total gastrectomy (54.5 percent). The medium surgical time, resection of lymph nodes, and hospital stay were 155 min, 24 and 6 days respectively. POM was 18.2 percent. With a median follow up of 22.5 months, a global actuarial SV was verified to 5 years 37 percent, and recurrence of 36.4 percent. The results achieved, in terms of POM, mortality and SV series are comparable to national and international centers.

A meta-analysis of cohort studies on the susceptibility of type 2 diabetes mellitus and gastric cancer / 中华内分泌代谢杂志

PubMed,Embase,Cochrane Library,and ISI web were searched without any limitations with regard to publication date or language,as well as the references of qualifying articles.All kinds of cohort studies comprising the risk of gastric cancer between diabetic patients and control subjects were included.We excluded studies that investigated only mortality but not incidence.25 studies met our criteria,and the qualities of these studies were evaluated using the Newcastle-Ottawa Quality Assessment Scale.Statistical analyses were carried out with STATA software version 12.0.A random-effects model meta-analysis showed an increased risk of gastric cancer in diabetic patients (RR =1.20,95 ％ CI 1.12-1.28).Subgroup analyses indicated that this result persisted in studies of both male(RR =1.15,95％ CI 1.02-1.29) and female (RR =1.29,95％ CI 1.09-1.53) subjects,in studies of European countries(RR =1.25,95％ CI 1.07-1.46) and Asia countries (RR =1.18,95％ CI 1.09-1.28).Compared with nondiabetics,the incidence of gastric cancer may be increased by approximately 20％ in diabetics.Thus diabetes may be an independent risk factor for gastric cancer.This effect tends to be more significant in type 1 and female patients.

Methylation of the Tumor Suppressor Gene RUNX3 in Human Gastric Carcinoma

BACKGROUND/AIMS: RUNX3 (PEBP2alphaC/CBFA3/AML2) is a novel tumor suppressor gene in the human gastric carcinoma. The aims of this study were to determine the methylation of RUNX3 promoter and the association between RUNX3 methylation and the clinicopathological characteristics of patients with gastric carcinoma. METHODS: Seventy-nine patients with gastric carcinoma were studied prospectively from April 2005 to May 2007. The methylations of RUNX3 promoter on the gastric carcinoma specimens and the corresponding nonneoplastic mucosa were evaluated by methylation-specific polymerase chain reaction. RESULTS: Comparison of the results with the clinicopathological characteristics identified RUNX3 monoallelic methylation in 32.9% (26/79) of the gastric carcinoma patients and in 11.4% (9/79) of those with nonneoplastic mucosa (p=0.053). The monoallelic methylated gastric carcinoma specimens predominantly consisted of well- and moderately differentiated carcinomas (44.7%), with the unmethylated group constituting 22.0% of them (p=0.031). Among the 48 patients (60.8%) who underwent gastrectomy, there was no correlation between the two groups with regard to Lauren's classification (p=0.235), depth of invasion (p=0.990), nodal status (p=0.601), stage (p=0.900), lymphatic invasion (p=0.537), and vascular invasion (p=0.815). CONCLUSIONS: Methylation of the tumor suppressor gene RUNX3 might be one of the mechanisms involved in the pathogenesis of gastric carcinoma.

Clinicopathlogic characteristics of multiple synchronous early gastric cancers / 대한내과학회지

BACKGROUND: With the progress of limited surgery and endoscopic treatment for early gastric cancer (EGC), multiple synchronous EGCs, a cause of recurrence, become more important. The objective of this study was to elucidate the characteristics of multiple synchronous EGCs with an emphasis on features of preoperatively undiagnosed lesions. METHODS: We retrospectively reviewed medical records of 496 patients who underwent a gastrectomy for EGC at our institution between January 2004 and December 2004. RESULTS: Twenty-four patients (4.8%) had multiple synchronous EGCs with 24 main and 27 accessory lesions. Multiple synchronous EGCs showed male predominance (p=0.03). Other characteristics including lymph node metastasis were the same as with single EGC. Out of 27 accessory lesions, six lesions (22%) were not detected preoperatively in six patients (25%). Macroscopically five lesions were flat and one lesion was depressed. Five lesions were located at the anterior or posterior wall of the middle and low third portion and one lesion was located at the lesser curvature side of the upper third portion of the stomach. Two lesions were 4 mm, one lesion was 8 mm, two lesions were 12 mm and one lesion was 15 mm in size (mean diameter = 9.1 mm). Histologically, four lesions were of the differentiated type and two lesions were of the undifferentiated type. CONCLUSIONS: Multiple synchronous EGCs have same clinicopathologic features as a single EGC except for male predominance. Considering the possibility of a synchronous lesion, one should examine the entire stomach precisely with special attention to the anterior, posterior wall and lesser curvature side of the same or neighboring area of a known EGC lesion before treatment.

Analysis of Genomic Imbalances in Korean Gastric Carcinoma Using Comparative Genomic Hybridization / 대한해부학회지

Chromosomal abnormalities, which are valuable markers for diagnosis and prognosis of cancer, provide useful clues in characterizing cancer at molecular level. Gastric cancer is the major cause of cancer deaths in Asian countries, including Korea. Genetic changes during the progression and metastasis of gastric cancer remain unclear. Recently, technique of degenerate oligonucleotide primed (DOP) PCR-comparative genomic hybridization (CGH) permits genetic imbalances screening of the entire genome using only small amounts of tumor DNA. In non-metastatic gastric cancers the common sites of copy number increases were detected at 8q (64%), 4p12-q24 (64%), 5p13-q23 (64%), 13q21-q32 (64%), 6q11-q21 (55%), 7q(50%), 14q11.2-q21 (45%), 3q11-q13.3 (41%), and 2q23-q32 (41%). In metastatic gastric cancers, the frequent sites of gains were detected at 8p21-qter (60%), 5 (54%), 20 (42%), 6pter-q24 (51%), 1q21-qter (46%), 3p14-qter (46%), 22q (46%), and 4 (43%). Deletion or chromosomal loss was found to be less frequent in this study. The frequent sites of copy number decreases were detected at 1p34-pter (23%), 16q23-q24 (18%), and 19q13 (18%) in non-metastatic gastric cancers. In metastatic gastric cancers, chromosome losses were detected at X (37%), 1p33-pter (37%), and 16p (23%). The recurrent gains and losses of chromosomal regions identified in this study provide candidate regions that may contain oncogenes or tumor suppressor genes respectively involved in the tumorigenesis of gastric cancer.

Sutureless Gastroduodenostomy after Radical Subtotal Gastrectomy

PURPOSE: A gastroduodenostomy (Billroth I) is the most physiologic reconstructive method available today, it has recently been used more frequently subsequent to radical subtotal gastrectomies for the treatment of gastric cancers. However, it is inevitable that gastroduodenostomies involving sutures or staples may have complications such as ulcers, bleeding, or constriction caused by remaining foreign materials. We analyzed the results of sutureless gastroduodeno stomies using biofragmentable anastomosis rings (BAR) with regard to safety, usefulness and profits. METHODS: Sutureless gastroduodenostomies using BAR (Valtrac, Davis & Geck Wayne, NJ) composed of polyglycolic acid and Barium for x-ray visualization, performed after radical subtotal gastrectomies in 17 gastric cancer patients in the period from 1999 to 2001. RESULTS: Five patients had early cancers and 12 had advanced cancers. The mean size of the tumor masses was 5.0 X 3.7 cm, and the mean lengths of the proximal and distal resection margins from the tumors were 7.6 cm and 3.0 cm respectively. The lengths of lesser curvature and greater curvature of the resection specimens were 10.6 cm and 20.5 cm respectively. Fourteen tumors were located in the antrum and the other 3 were located in the body. The mean operating time was 164.4+/-35.2 min., and the mean hospital stay was 14.1+/-3.1 days. Sips of water could be started 4.4+/-0.5 days after the operation. In all patients, the sutureless gastroduodenostomy site appeared watertight and maintained its initial burst strength, which was verified using gastrografin x-ray visualization performed 1 week after the operation. There were no anastomosis related complications in any of the patients; except for two mild satiety, which were treated quickly by the patients themselves. The BAR began to fragment 3 weeks after the operation, and disappeared completely within 4 weeks. The diameters of the anastomosis sites were large enough to pass foods without constriction and no other secondary changes developed in the Barium x-ray visualization or endoscopic examination, which was performed 1 month after the operation. CONCLUSION: A sutureless gastroduodenostomy using BAR is a safe, easy, and efficient reconstructive method to be used subsequent to a radical subtotal gastrectomy for gastric cancers.

Sutureless Gastroduodenostomy

A gastroduodenostomy is the most physiological reconstruction after a distal gastrectomy. However, a gastroduodenostomy with either sutures or staples has many complications. These include bleeding, leakage and stenosis. A sutureless gastroduodenostomy with a biofragmentable anastomosis ring (BAR) in was used adenocarcinoma patients to prevent these complications from 1999. A BAR is composed of polyglycolic acid and Barium sulfate to allow for X-ray visualization. Hardy in first introduced the BAR in 1985. Since then, it has been used in an anastomosis of the colon or small bowel surgery but its use in a gastroduodenostomy is the first trial in the world. A 70 year male patient, old who received a subtotal gastrectomy (Billroth I), underwent a A sutureless gastroduodenostomy with a BAR. The gastroduodenostomy with the BAR was watertight and maintained the initial burst strength in the gastrografin X-ray study performed at the postoperative 1 week. The BAR began to fragment 3 weeks after the operation and disappeared from the digestive tract completely. The diameter of the anastomosis site was sufficient for passed foods. No other secondary changes from remained foreign bodies were found in the endoscopic examination. In a second operation to treat a primary hepatoma, there was no adhesive changes around the gastroduodenostomy site. In conclusion, a sutureless gastroduodenostomy with BAR is a safe, easy and efficient reconstructive method after a distal gastrectomy.