Diffuse Infiltrative Splenic Lymphoma: Diagnostic Efficacy of Arterial-Phase CT

OBJECTIVE: To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL). MATERIALS AND METHODS: One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings. RESULTS: Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively). CONCLUSION: Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.

Pancreatic Arteriovenous Malformation as an Unusual Cause of Chronic Gastrointestinal Bleeding in a Patient with Early Gastric Cancer: Multimodality Imaging Spectrum with Pathologic Correlation

Arteriovenous malformation (AVM) of the pancreas is extremely rare, although it may be increasingly diagnosed due to the widespread use of cross-sectional imaging of the abdomen. Early diagnosis of this disease is important to prevent delay of treatment and resulting fatal complications. We report a rare case of pancreatic AVM in a 48-year-old man who presented with severe chronic anemia and early gastric cancer, which made diagnosis challenging. Imaging findings, including ultrasound, computed tomography, and magnetic resonance imaging, are shown, as well as the pathologic features.

Comparison of Internally Cooled Wet Electrode and Hepatic Vascular Inflow Occlusion Method for Hepatic Radiofrequency Ablation

BACKGROUND/AIMS: Various strategies to expand the ablation zone have been attempted using hepatic radiofrequency ablation (RFA). The optimal strategy, however, is unknown. We compared hepatic RFA with an internally cooled wet (ICW) electrode and vascular inflow occlusion. METHODS: Eight dogs were assigned to one of three groups: only RFA using an internally cooled electrode (group A), RFA using an ICW electrode (group B), and RFA using an internally cooled electrode with the Pringle maneuver (group C). The ablation zone diameters were measured on the gross specimens, and the volume of the ablation zone was calculated. RESULTS: The ablation zone volume was greatest in group B (1.82+/-1.23 cm3), followed by group C (1.22+/-0.47 cm3), and then group A (0.48+/-0.33 cm3). The volumes for group B were significantly larger than the volumes for group A (p=0.030). There was no significant difference in the volumes between groups A and C (p=0.079) and between groups B and C (p=0.827). CONCLUSIONS: Both the usage of an ICW electrode and hepatic vascular occlusion effectively expanded the ablation zone. The use of an ICW electrode induced a larger ablation zone with easy handling compared with using hepatic vascular occlusion, although this difference was not statistically significant.

Lymphocytic Phlebitis of the Stomach: A Case Report with Literature Review

Lymphocytic phlebitis of gastrointestinal (GI) tract is a rare diseaes. Approximately 50 cases of lymphocytic phlebitis of the GI tract have been reported. Most of these involved the colon or small intestine and presented as acute abdomen. We report the second case of lymphocytic phlebitis of the stomach. A 73-year-old female complaining of dizziness had endoscopic and computed tomography findings strongly suggested gastric cancer, while gastric biopsy was negative for carcinoma. The partial gastrectomy specimen showed lymphocytic phlebitis involving veins in the submucosa, muscularis propria, and serosa while the adjacent arteries were spared. The veins were mainly surrounded by lymphocytes. When a patient has a lesion in the GI tract that is suggesting cancer without biopsies revealing any carcinoma, the pathologist should recommend a deeper biopsy for a proper examination of the submucosa.

A Case of Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma Arising from Ultrashort-Segment Barrett's Esophagus / 대한소화기내시경학회지

Barrett's esophagus is defined as the replacement of normal squamous epithelium of distal esophagus with specialized columnar epithelium. This condition is considered to be a premalignant lesion of esophageal adenocarcinoma. Barrett's esophagus is classified into long-segment (> or = 3 cm in length) and short-segment ( <3 cm in length). Detection of the former is more difficult. Adenocarcinomas arising from short-segment Barrett's esophagus are uncommon in Korea. Barrett's adenocarcinoma restricted to the mucosa can be treated by endoscopic mucosectomy. In recent years, endoscopic submucosal dissection for early esophageal cancer has been extensively applied because it is a reliable method to achieve en bloc resection. In this paper, we report a case of esophageal adenocarcinoma arising from ultrashort-segment Barrett's esophagus, which was successfully resected by endoscopic submucosal dissection.

Evaluation of Automatic Image Segmentation for 3D Volume Measurement of Liver and Spleen Based on 3D Region-growing Algorithm using Animal Phantom / 의학물리

Living donor liver transplantation is increasingly performed as an alternative to cadaveric transplantation. Preoperative screening of the donor candidates is very important. The quality, size, and vascular and biliary anatomy of the liver are best assessed with magnetic resonance (MR) imaging or computed tomography (CT). In particular, the volume of the potential graft must be measured to ensure sufficient liver function after surgery. Preoperative liver segmentation has proved useful for measuring the graft volume before living donor liver transplantations in previous studies. In these studies, the liver segments were manually delineated on each image section. The delineated areas were multiplied by the section thickness to obtain volumes and summed to obtain the total volume of the liver segments. This process is tedious and time consuming. To compensate for this problem, automatic segmentation techniques have been proposed with multiplanar CT images. These methods involve the use of sequences of thresholding, morphologic operations (ie, mathematic operations, such as image dilation, erosion, opening, and closing, that are based on shape), and 3D region growing methods. These techniques are complex but require a few computation times. We made a phantom for volume measurement with pig and evaluated actual volume of spleen and liver of phantom. The results represent that our semiautomatic volume measurement algorithm shows a good accuracy and repeatability with actual volume of phantom and possibility for clinical use to assist physician as a measuring tool.

Ultrasonography-guided Balloon Angioplasty in an Autogenous Arteriovenous Fistula: Preliminary Results

PURPOSE: Percutaneous trasnluminal angioplasty (PTA) of a malfunctioning arteriovenous fistula (AVF) in hemodialysis patients requires the use of contrast angiography and fluoroscopy guidance. We attempted to perform this procedure under duplex ultrasound guidance to reduce the amount of contrast agent administered and to reduce the radiation dose during the interventional procedures. MATERIALS and METHODS: From September 2006 to February 2007, 45 patients received interventional treatment due to malfunctioning hemodialysis access in our hospital. Among the patients, we selected 10 patients diagnosed with stenosis of an autogenous arteriovenous fistula based on a physical examination. There were six males and four females aged 51-78 years (mean age, 59 years). Seven of these patients had a Brescia-Cinimo type fistula and three patients had a basilic vein transposition. All procedures were performed in the angiography suite. All procedures that required angioplasty were performed under duplex ultrasound guidance and then contrast angiography was performed to confirm the final patency of the vessels. Conventional angioplasty was also performed under fluoroscopy guidance for any lesions that required an additional angioplasty. The volume flow before and after the PTA and procedure time were recorded. Clinical success was defined as the performance of one or more successful hemodialysis sessions after treatment. RESULTS: Eight of ten patients did not require an additional angioplasty by conventional angiography after the duplex- guided angioplasty. One case showed recoiling of stenosis after the duplex-guided PTA and another case was missed at duplex scanning due to the extremely short nature of the recoiling of stenosis. The mean volume flow before and after PTA was 167 ml/min (range, 80-259 ml/min) and 394.2 ml/min (range, 120-586 ml/min), respectively. No complications associated with the duplex-guide procedure occurred. In nine cases, PTA enabled hemodialysis to be conducted more than one time. In one case, hemodialysis was not possible to perform due to an inadequate maturation of a fistula. The mean duration of the procedure was 38 minutes (range, 23-50 minutes). CONCLUSION: Duplex-guided percutaneous angioplasty of autogenous AVF stenosis in hemodialysis patients is technically feasible and can be used as an ancillary method in addition to the use of the conventional fluoroscopy- guided method.

Normal Appendix in Adults: MDCT Findings about the Location, Thickness and the Presence or Absence of Intraluminal Gas

PURPOSE: We wanted to examine the usefulness of multi-detector CT (MDCT) with multiplanar reformations for evaluating the location, thickness and the presence or absence of intraluminal gas in the normal appendix of adults. MATERIALS AND METHODS: From December 2004 to June 2005, we evaluated normal appendices in 427 consecutive adult patients who were scanned with 16-slice MDCT. All these patients had no clinical findings of appendicitis. There were 251 men and 176 women. The age range was 19-84 years (mean age: 55 years). The contrast-enhanced MDCT scans during the portal phase were obtained with 0.75 mm detector collimation and they were reviewed with using the multiplanar reconstruction images (3 mm section thickness). The MDCT images of normal appendices on a PACS monitor were retrospectively analyzed. We analyzed the location, thickness and the presence or absence of intraluminal gas by consensus of two abdominal radiologists. The positions of normal appendices were classified as type I (postileal and medial paracecal), type II (subcecal), type III (retrocecal and retrocolic or laterocolic), type IV (preileal and medial colic) and type V (lower pelvic cavity). RESULTS: The five types of appendiceal locations were as follows; type I (n=187; 44%), type II (n=78; 18 %), type III (n=92; 22%), type IV (n=39; 9%) and type V (n=31; 7%). The appendiceal tips in 29 cases (7%) were unusually located in the right subhepatic space, the small bowel mesentery and the right adnexa. The mean thickness of 427 appendices was 5.8+/-0.9 mm (range: 3.8-9.2 mm). The appendiceal mean thickness was 5.9+/-0.9 mm in men and 5.7+/-0.9 mm in women (p < 0.05). 384 (90%) of 427 appendices had intraluminal gas and 43 (10%) had no intraluminal gas, and their mean thickness was 5.9 mm (range: 3.8-9.2 mm) and 5.3 mm (3.8-7.3 mm), respectively (p < 0.05). CONCLUSION: MDCT with multiplanar reformations was useful for evaluating the location, thickness and the presence or absence of intraluminal gas in normal appendix of adults. These MDCT findings may be helpful in diagnosing equivocal appendicitis or appendicitis with unusual location.

Hyperplastic Polyp Arising from Endoscopic Mucosal Resection Site of Early Gastric Cancer: A Case Report

Hyperplastic polyps are common gastric lesions that are characterized by nonneoplastic epithelial hyperplasia. However, to our knowledge, there are no reports of a hyperplastic polyp arising from an endoscopic mucosectomy site of early gastric cancer. We describe the CT findings with a histopathology correlation in a case of a hyperplastic polyp arising from a mucosectomy site that mimicked polypoid gastric cancer.

Usefulness of Helical CT for the Preoperative Evaluation of Small Advanced Gastric Cancer Mimicking as Early Gastric Cancer at Endoscopy

PURPOSE: We wanted to evaluate the usefulness of helical CT, along with histopathologic correlation, for the preoperative evaluation of small advanced gastric cancers (AGCs) mimicking as early gastric cancer (EGCs) at endoscopy. MATERIALS AND METHODS: From February 2001 to September 2004, we retrospectively reviewed 17 patients with pathologically proven small AGCs that were misinterpreted as EGCs at endoscopy. The preoperative helical CT findings were prospectively analyzed and the CT staging was compared with the pathologic staging that was based on the depth of tumor invasion and status of lymph node metastasis, according to the TNM classification. RESULTS: The endoscopic findings of the 17 AGCs misinterpreted as EGCs were type IIc (n=7), IIb+IIc (n=3), IIa+IIc (n=3), IIa+IIb (n=1), and III (n=3). The mean size of the AGCs on the gross specimen was 2.8 cm (range: 1.2 cm-5 cm). Helical CT clearly depicted the depth of tumor invasion by the marked transmural enhancement or the reticular strands in the exraserosal fat. Preoperative helical CT detected all 17 AGCs (100%) and it correctly diagnosed then as AGCs in 15 (88%) of 17 cases. CT staging for the T category correctly staged 12 cases (71%), it understaged four cases and it overstaged one case. Regional lymph node metastasis was positive in 11 (64%) of 17 cases on the pathologic examination. The CT staging for the N category correctly staged 10 (59%) of 17 cases, it understaged four cases, and it overstaged three cases. CONCLUSION: Preoperative helical CT correctly diagnosed small AGCs mimicking as EGCs at endoscopy. Our results show that helical CT can be useful for the decision-making during the treatment planning for those patients with gastric cancer in which the endoscopic distinction between EGC and AGC is difficult.

Neuroblastoma Arising in a Retroperitoneal Mature Cystic Teratoma: Case Report

Malignant transformation of mature cystic teratoma is rare and the vast majority are squamous cell carcinoma, but neuroblastomas are extremely rare. We report a case of neuroblastoma arising in a mature cystic teratoma of the retroperitoneum. In a 24-year-old woman with intermittent abdominal pain, sonogram and CT scan show a multiloculated cystic mass with calcification, fat, septum, and small solid component in the left retroperitoneal space. Complete surgical resection of the cystic mass was done and a small neuroblastoma in the septum of the cystic mass was incidentally detected at histopathologic examination.

Mesenteric Paraganglioma with Cystic Degeneration: Case Report

Extra-adrenal abdominal paragangliomas are rare. Most arise from the organs of Zuckerkandl, involve large concentrations of paraganglionic tissue, and are located in the para-aortic space along the sympathetic chain. Published reports have, however, described normal paraganglionic tissue at the root of the mesentery which serves as the superior limit of the organs of Zuckerkandl, and mesenteric paraganglioma is very rare. We report a case of paraganglioma with cystic degeneration arising from the mesentery.

Examination of Endoscopic Mucosal Resection as a Curative Treatment of Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The purpose of this study was to define the indication and limitation of EMR of EGC. METHODS: We studied thirty-five cases of EGC treated by EMR in Chungnam National University Hospital from January, 1999 to July, 2001. RESULTS: The rate of complete resection on EGC was 94.3% (33/35). The size affected the curability; 94.4% (17/18) of lesions less than 10 mm, 93.3% (14/15) of lesions 11 to 20 mm and 100% (2/2) of those larger than 20 mm were resected completely. The depth of cancer invasion also affected the curability; 100% of lesion was confined to mucosa while 71.4% of those invaded submucosa. Of the thirty-three lesions which were completely resected, twenty-seven lesions had no recurrences during the follow-up period, four lesions were residual cancers and two developed local recurrences. CONCLUSIONS: In curative treatement for EGC with EMR, although follow-up period was short there is a possibility that indications for EMR could extend to the elevated lesion which is larger than 20 mm and to the superficial submucosal (sm1) cancer.

Tuberculous Abscess of the Pancreas Presenting as Obstructive Jaundice: A Case Report

Pancreatic tuberculosis is very rare, though dissemination to the gastrointestinal tract and mesenteric lymph nodes is common. We describe a case of pancreatic tuberculosis presenting as a cystic mass in the pancreatic head, with biliary obstruction, in a patient with miliary pulmonary tuberculosis. Surgery for the curative treatment of jaundice was performed, and the histopathologic findings indicated that a pancreatic abscess with caseous necrosis was present, consistent with tuberculosis.

Remote Metastasis to the Gastric Cardia in Esophageal Carcinoma: CT Findings

PURPOSE: To assess the CT findings of remote metastasis to the gastric cardia in patients with esophageal carcinoma. MATERIALS AND METHODS: Among patients with esophageal carcinomas treated between June 1994 and May 1999, five males aged 65-75 (mean, 67.4) years with histologically proven remote metastasis to the gastric cardia from esophageal squamous cell carcinoma, detected at surgery (n=2) or endoscopic biopsy (n=3), underwent CT scanning. We retrospectively evaluated the findings in terms of the location, size and appearance of each lesion and the presence or absence of associated lymphadenopathy. RESULTS: The primary esophageal carcinomas were located in the middle third (n=4) and lower third (n=1) of the esophagus. All five gastric metastases were solitary and occurred in the gastric cardia, and were separated from the primary tumors. CT showed that the metastases ranged in size from 4.2 to 8.0 (mean, 6.7) cm, and all were larger than the primary tumors. All were ulcerated, and in four cases there was associated abdominal lymphadenopathy. They were all well defined, poorly enhanced, submucosal masses that were endogastric in three cases and exogastric in two. The latter were difficult to differentiate from extrinsic masses compressing the gastric cardia. CONCLUSION: Our results suggest that when a submucosal gastric cardial mass with associated lymphadenopathy is detected by CT during the initial staging or follow-up evaluation of esophageal carcinoma, remote gastric metastasis should be considered.

Pylorus-preserving Proximal Gastrectomy vs. Total Gastrectomy with Jejunal Interposition for Proximal Gastric Adenocarcinomas

PURPOSE: The aim of this study was to evaluate the short- term outcome of a pylorus-preserving proximal gastrectomy by comparing it with a jejunal interposition after a total gastrectomy in proximal gastric adenocarcinoma. MATENRIALS AND METHODS: For 22 patients (12 men and 10 women) who underwent a pylorus-preserving proximal gastrectomy, several clinical parameters were obtained from the medical records retrospectively. In this study, the data were collected between September 1993 and December 1999 at Chungnam National University Hospital, and the results were compared with those of 25 patients (17 men and 8 women) who underwent an isoperistaltic simple jejunal interposition. RESULTS: The average operative time in the pylorus-preserving proximal gastrectomy group (220 minutes) was shorter than that in the jejunal interposition group (243 minutes) (P<0.05). The hemoglobin and hematocrit levels were significantly higher in the pylorus-preserving proximal gastrectomy group at 2 years after the operation. The body weight ratio (postoperative body weight/preoparative body weight) in patients who had a pylorus-preserving proximal gastrectomy was significantly higher than that in patients with a jejunal interposition at 2 years after the operation. The jejunal interposition procedure had better outcomes in anastomotic site stricture, duration of hospital stay, and number of removed lymph nodes (P<0.05). CONCLUSION: We think that from the viewpoint of quality of life, a pylorus-preserving proximal gastrectomy, as well as a jejunal interposition, is a useful reconstruction method for early adenocarcinomas of the proximal stomach. However, stricture of the esophagogastrostomy site in the pylorus- preserving proximal gastrectomy is a common problem to be solved in the future.

A Clinical Study of the Uncut Roux-en-Y Gastrojejunostomy Using a Short Roux Limb after Subtotal Gastrectomy

PURPOSE: The restoration of intestinal continuity following subtotal gastrectomy for gastric malignancy as well as benign gastric disease is an important area for research. The aim of this study was to compare the uncut Roux-en-Y reconstruction using a short Roux limb (20 to 30 cm) with the uncut Roux-en-Y reconstruction using a long Roux limb (more than 40 cm). METHODS: 48 patients (33 men and 15 women) underwent uncut Roux-en-Y reconstruction using a short Roux limb (short Roux limb group), and 32 patients (19 men and 13 women) had the Roux-en-Y operation using a long Roux limb (long Roux limb group). We assessed the outcome of these operations on the occurrence of Roux stasis syndrome, the endoscopic findings, and the required period for the nasogastric tube. RESULTS: Roux stasis syndrome occurred in 9 patients (18.8%) in the short Roux limb group, and in 10 patients (31.3%) in the long Roux limb group (p value 0.201). Pathological endoscopic finding were observed in 5 patients (10.4%) in the short Roux limb group, and in 6 patients (18.8%) in the long Roux limb group (p=0.292). CONCLUSION: Comparing the short Roux limb group with the long Roux limb group in uncut Roux-en-Y reconstruction after subtotal gastrectomy, We can conclude that uncut Roux-en-Yreconstruction using a short Roux limb is an effective reconstruction procedure to alleviate Roux stasis syndrome, reflux gastritis and esophagitis.

Jejunal Interposition after Total Gastrectomy

PURPOSE: The aim of this study was to evaluate the short-term outcome of a jejunal interposition, by comparing it with a conventional Roux-en-Y gastrojejunostomy, after a total gastrectomy. MATENRIALS AND METHODS: For 28 patients (20 men and 8 women) with a gastric adenocarcinoma, who underwent an isoperistaltic simple jejunal interposition, weight, hemoglobin, hematocrit, serum protein and albumin, and cholesterol levels were checked before the operation and at 1 year and 2 years after the surgery. Also, endoscopy was performed to confirm reflux esophagitis. In this study, the data were collected between January 1993 and July 1999 at Chungnam National University Hospital, and the results were compared with those of the Roux-en-Y procedure. RESULTS: The body weights at 1 year and 2 years after the surgery had returned to 86.0% and 87.6% of the recent original body weight in the jejunal interposition (JI) group and to 90.8%, 87.0%, respectively in the Roux-en-Y (RY) group. The levels of hemoglobin (g/dl) were 13.3, 12.5, and 11.9 in the JI group, and 13.8, 12.6, and 12.1 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum protein (g/dl) levels were 7.1, 7.2, and 7.5 in the JI group and 7.1, 7.0, and 7.2 in the RY gropu at the time of the operation and at 1 year and 2 years after the surgery, respectively. The serum albumin (g/dl) levels were 4.2, 4.1, and 4.2 in the JI group and 4.2, 4.2, and 4.2 in the RY group at the time of the operation and at 1 year, and 2 years after the surgery, respectively. The total serum cholesterol (mg/dl) levels were 186.5, 174, and 164 in the JI group and 213.7, 171.1, and 141.0 in the RY group at the time of the operation and at 1 year and 2 years after the surgery, respectively. The endoscopic finding showed that reflux esophagitis occurred in 7.1% of the patients in the JI group and in 3.5% in the RY group. CONCLUSION: We think that from the view point of quality of life, a jejunal interposition, as well as a Roux-en-Y procedure, is a useful reconstruction methods for a total gastrectomy.

Endoscopic diagnosis of the depth of invasion in early gastric cancer / 대한내과학회지

BACKGROUND: In order to decide on a strategy of the treatment against gastric cancer, an accurate preoperative evaluation of the depth of tumor invasion is essential. We have studied the depth of invasion in early gastric cancer by endoscopic findings.METHODS: The preoperative endoscopic diagnosis of the depth of invasion was compared with pathologic findings in a total of 108 cases with early gastric cancers (EGC) which were confirmed pathologically in resected specimen. RESULTS: Of one hundred eight EGCs, forty-one were elevated type, others were flat-depressed type. There was no relationship between the depth of invasion and macroscopic type of EGC. All of the elevated typed EGCs were differentiated carcinoma. In the depressed typed EGCs, Forty-five percent was differentiated carcinoma and fifty-five percent was undifferentiated carcinoma. The incidence of lymph node metastasis in submucosal cancers (14.8%) was significantly more than in mucosal cancers (1.6%). Among the submucosal cancers, the incidence of nodal metastasis in double lesions (100%) was significantly more than in single lesions (14.8%). In the elevated typed EGCs, mucosal cancers were small in size less than 3.0 cm (83%), and contained whitish patches, and showed uneveness and erosion. Submucosal cancers were large in size, and contained ulcers, and showed submucosal tumor-like shapes and bridging folds. In the depressed typed EGCs, it was difficult to determine endoscopically the depth of invasion. Submucosal cancers showed the fusion of converging folds and unevenness of the depressed base. The regularity of the depressed base without ulcer was primarily found in mucosal cancer. CONCLUSION: When the tumor was elevated, the endoscopic diagnosis for the depth of invasion was determined easily by size of the lesion and features of the elevated surface. For the depressed tumor, diagnostic clues were the pattern of the base of the depression and the converging fold, and the endoscopic diagnosis of the depth of invasion was much more difficult than the elevated type EGC.

Roux Stasis Syndrome in Conventional Roux-en-Y Gastrojejunostomy and Uncut Roux-en-Y Gastrojejunostomy after Subtotal Gastrectomy

PURPOSE: Roux stasis syndrome is the main complication of a Roux-en-Y gastrojejunostomy. The aim of this study was to compare the occurrence rate of Roux stasis syndrome with the passing of time in a conventional Roux-en-Y gastrojejunostomy and in an uncut Roux-en-Y gastrojejunostomy. MATENRIALS AND METHODS: 50 patients (31 men and 19 women) had a conventional Roux-en-Y reconstruction and 53 patients (35 men and 18 women) had an uncut Roux-en-Y reconstruction. The Roux stasis syndrome was defined by clinical criteria only. The criteria included one of the four following conditions at the time of follow-up: chronic upper abdominal pain, postprandial fullness, persistent nausea, and intermittent vomiting that are worsened by eating. Follow-up after surgery was done in all patients at 7~12, 13~18, 19~24, 25~30, and 31~36 months. RESULTS: According to the criteria, the Roux stasis syndrome occurred in 40.0% of the patients at 7~12 months, 33.3% at 13~18 months, 35.3% at 19~24 months, 32.0% at 25~30 months, and 33.3% at 31~36 months after a conventional Roux-en-Y operation. The syndrome occurred in 22.6% of the patients at 7~12 months, 15.2% at 13~18 months, 17.1% at 19~24 months, 19.2% at 25~30 months, and 20% at 31~36 months after an uncut Roux-en-Y reconstruction. Conclusion: In terms of occurrence pattern, only a little variance existed one year after both procedures. Comparing the Roux stasis syndrome in both procedures, the uncut Roux operation had better results than the conventional Roux operation.