Roux-en-Y esophagojejunostomy after total gastrectomy: Clinical and functional sequelae [Sequele clinico-funzionali dopo gastrectomia totale ed esofago-digiunoanastomosi sec. Roux-en-Y]

Abstract Background. Roux-en-Y esophagojejunostomy after total gastrectomy may be followed by malnutrition, esophageal biliary reflux and change of intestinal transit time. However, the true incidence and clinical relevance of such disturbances are not fully evaluated since in the literature they are reported with a wide variability. Methods. In this study, clinical and functional alterations after Roux-en-Y esophagojejunostomy in 15 patients has been investigated. All patients have been followed after 6 months from the operation and after 6-21 months. In the last control, they underwent blood cells count and chemistry, Nutritional Index according Buzby, fecal chemical evaluation, upper endoscopy and biopsy, upper G.I. series, HIDA, and finally intestinal transit scan. Results. At 6 months from operation 53.3% of patients reported clinical alterations, 26.6% at the next control. Mild anemia was observed in 3 patients (20%) and malnutrition in 26.6%. High levels of fecal fat were reported in 20% of the patients. Endoscopy and histology of the esophagus and jejunal loop were normal; an anastomotic cancer recurrence was observed in one patient. HIDA scan did not show biliary reflux in the esophagus. In all but one case (recurrence), the emptying time of the jejunal loop (25 ± 5') was comparable to that of the stomach of healthy individuals. Conclusions. The results seem to indicate that changes of intestinal physiology are not routinely observed after Roux-en-Y esophagojejunostomy and, if present, they do not seem to influence the clinical condition of the patient.