Clinical Effects of a Braun Enteroenterostomy in Patients with a Subtotal Gastrectomy

ABSTRACT

BACKGROUNDSDuring the past two decades, a dramatic increase has been seen in the diagnosis and treatment of alkaline reflux gastritis (ARG). Recently, the number of symptomatic, medically resistant postgastrectomy patients with ARG experiencing enterogastric reflux has increased as documented by clinical symptoms, gastroscopy, quantitative radionuclide biliary scanning, and biochemical study. Even the number of asymptomatic patients experiencing enterogastris refluy or ARG after gastrectomy has increased. METHODS: In a retrospective study, we evaluated an efficacy of an additional Braun enteroenterostomy (BEE) in preventing the ARG by diverting bile away from the stomach in 72 patients with gastric cancer (51 with BEE and a control of 21 without BEE) who underwent a subtotal gastrectomy. The BEE was performed about 20 to 30 cm from the gastrojejunostomy. Seventy-two patients had their clinical symptoms recorded and underwent radiologic study, gastroscopy, and biopsy. RESULTS: The present study demonstrated the following1) Of the 51 patients who underwent BEE, twelve (23.5%) developed ARG symptoms and required medication. Of the 21 control patients without BEE, twelve (54.6%) developed ARG symptoms and required medical treatment. 2) The postoperative gastroendoscopic findings in the 51 patients who underwent BEE were grade 1 in 27 (52.9%) patients, grade 2 in 16 (31.4%) patients and grade 3 in only one patient versus grade 1 in 5 (22.7%) patients, grade 2 in 13 (59.1%) patients and grade 3 (9.1%) patients without BEE. CONCLUSIONS: BEE was an effective procedure for reducing the risk of ARG caused by reflux of bile.