• bariatric surgery
• esophageal cancer (ec)
• esophagectomy
• malabsorption
• malnutrition risk
• micronutrient deficiencies
• post-bariatric surgery
• primary gastric carcinoma

Delayed gastric emptying (DGE) after distal gastrectomy impacts patients’ nutritional status and quality of life. The current treatments of DGE seem unsatisfactory or need invasive interventions. It is unknown whether transcutaneous electroacupuncture (TEA) is effective in treating DGE.

A total of 90 eligible participants who underwent distal gastrectomy will be randomly allocated to either the TEA group (n = 60) or the sham transcutaneous electroacupuncture (sham-TEA) group (n = 30). Each participant will receive TEA on the bilateral acupoints of Zusanli (ST36) and Neiguan (PC6) for 4 weeks. The primary outcomes will be the residual rates of radioactivity in the stomach by gastric scintigraphy and total response rates. The secondary outcomes will be endoscopic features, autonomic function, nutritional and psychological status, serum examination, and quality of life (QoL). The adverse events will also be reported. The patients will be followed up 1 year after the treatment.

The findings of this randomized trial will provide high-quality evidence regarding the efficacy and safety of long-term TEA for treating DGE after distal gastrectomy.

Chinese Clinical Trial Registry ChiCTR2000033965. Registered on 20 June 2020

• Delayed gastric emptying
• Distal gastrectomy
• Gastric cancer
• Transcutaneous electroacupuncture

Delayed gastric emptying usually manifests as gastric food retention. This study aimed to evaluate the incidence of gastric food retention after distal gastrectomy with gastrojejunostomy in gastric cancer patients and identify the risk factors for its development.

We retrospectively enrolled 245 patients who underwent distal gastrectomy with gastrojejunostomy for gastric cancer at Boramae Medical Center between March 2017 and December 2019. We analyzed the presence of gastric food residue via computed tomography (CT) scans at 3 and 12 months postoperatively and analyzed the risk factors that may influence the development of gastric food retention.

CT scans were performed on 235 patients at 3 months and on 217 patients at 12 months postoperatively. In the group that received closure of Petersen's space, the incidence of gastric food retention was significantly low as per the 3- and 12-month postoperative follow-up CT scans (P=0.028 and 0.003, respectively). In addition, hypertension was related to gastric food retention as per the 12-month postoperative follow-up CT scans (P=0.011). No other factors were related to the development of gastric food retention. In the multivariate analysis, non-closure of Petersen's space (hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.20–5.38; P=0.010) was the only significant risk factor for gastric food retention at 3 months postoperatively, while non-closure of Petersen's space (HR, 2.81; 95% CI, 1.40-5.64; P=0.004) and hypertension (HR, 2.30; 95% CI, 1.14–4.63; P=0.020) were both significant risk factors for gastric food retention at 12 months postoperatively.

Closure of Petersen's space has an effect on decrease the incidence of gastric food retention after distal gastrectomy with gastrojejunostomy in gastric cancer patients.

• Gastric emptyng
• Internal hernia
• Stomach neoplasms

To report our experience of endoscopic botulinum toxin injection in patients who experienced severe delayed gastric emptying after pylorus-preserving gastrectomy (PPG).

We reviewed the medical records of 6 patients who received the botulinum toxin injection. They presented with severe delayed gastric emptying in the early postoperative period. Endoscopic botulinum toxin was administered as 4 injections of 25−50 IU into each of the 4 quadrants of the prepyloric area.

All botulinum toxin injections were successful without any complications, enabling 5 patients to tolerate soft solid diets and one to tolerate a soft fluid diet within 10 days. The endoscopic criteria of 4 patients improved. Symptom recurrence caused 2 patients to undergo repeat injections that were successful. The median follow-up period was 27 months, and all patients could ingest normal regular diets at the last follow-up.

Endoscopic botulinum toxin injection is a feasible treatment option for early delayed gastric emptying after PPG.

• Botulinum toxins
• Complications
• Endoscopy
• Gastrectomy
• Gastric stasis
• Surgery

• Bile reflux
• Dumping
• Nutritional deficiencies
• Postgastrectomy syndromes
• Roux-en-Y

The aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy.

This study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604). With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with ^99mTc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated.

In all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation) in the Roux-en-Y group and 89.4±37.8 minutes in the “J-pouch” group; the difference was statistically significant (P<0.001). Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation) in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016). There were no important adverse events.

After total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction. Whether these two observations have a direct causative link remains unanswered.

• J-pouch
• Roux-en-Y
• dynamic scintigraphy
• gastrectomy
• gastric emptying
• quality of life

• Atrophic gastritis
• Gastrectomy
• Gastric stump
• Helicobacter pylori
• Metaplasia
• Stomach neoplasms
• Stomach ulcer
• Treatment outcome

• Animals
• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/therapeutic use
• Drug Administration Schedule
• Drug Therapy, Combination
• Gastrectomy/adverse effects
• Gastric Stump/pathology
• Helicobacter Infections/blood
• Helicobacter Infections/diagnosis
• Helicobacter Infections/drug therapy
• Helicobacter Infections/microbiology
• Helicobacter pylori/drug effects
• Helicobacter pylori/growth & development
• Helicobacter pylori/pathogenicity
• Humans
• Neoplasms, Second Primary
• Postoperative Care
• Postoperative Complications/diagnosis
• Postoperative Complications/microbiology
• Postoperative Complications/prevention & control
• Proton Pump Inhibitors/administration & dosage
• Proton Pump Inhibitors/therapeutic use
• Risk Factors
• Serologic Tests
• Stomach/microbiology
• Stomach/surgery
• Stomach Neoplasms/microbiology
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors
• Treatment Outcome

• Double-Blind Method
• Endoscopy, Gastrointestinal/methods
• Erythromycin/administration & dosage
• Erythromycin/analogs & derivatives
• Female
• Follow-Up Studies
• Gastrectomy/methods
• Gastric Mucosa/drug effects
• Gastric Mucosa/pathology
• Gastrointestinal Agents/administration & dosage
• Gastrointestinal Motility/drug effects
• Gastroparesis
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Postoperative Period
• Premedication/methods
• Prospective Studies
• Risk Factors

• Aged
• Diet
• Fasting
• Female
• Food
• Gastrectomy/methods
• Gastroscopy/methods
• Humans
• Male
• Middle Aged
• Postoperative Care/methods
• Prospective Studies
• Retreatment
• Stomach Neoplasms/surgery
• Treatment Failure

Food residue is frequently observed in the gastric remnant after distal gastrectomy, despite adequate preparation. We devised a water-intake method to reduce food residue in the gastric remnant by drinking large quantities of water in a short time. The aims of this study were to identify the risk factors for food residue and to study the effectiveness of this new method for endoscopy preparation.

A cohort of 708 patients who underwent distal gastrectomy for gastric cancer was reviewed prospectively. Sixty patients with large amounts of food residue were randomly divided into two groups: a water-intake group (n=40) and a prolonged fasting group (n=20).

The incidences of a large amount of food residue were 15.7%, 5.8%, 7.5%, and 2.8% at 3, 12, 24, and 36 months, respectively, after distal gastrectomy. Independent risk factors for food residue were endoscopy at 3 months, diabetes mellitus, a body mass index of <19.5, and laparoscopic surgery. The proportion of successful preparations at follow-up endoscopy was higher for the water-intake group (70%) than for the prolonged fasting group (40%, p=0.025).

The water-intake method can be recommended as a preparation for endoscopy in patients who have had repetitive food residue or risk factors after distal gastrectomy.

• Distal gastrectomy
• Endoscopy
• Food residue
• Stomach neoplasms

AIM: To investigate the flow and mixing at the duodenal stump after gastric resection, a computer simulation was implemented.

METHODS: Using the finite element method, two different Billroth II procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity, pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.

RESULTS: The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. Case A had a more favorable pressure distribution in comparison with case B. However, case B had better performance in terms of food transport because of more continual food distribution, as well as better emptying of the duodenal section.

CONCLUSION: This study offers insight into the transport process within the duodenal stump section after surgical intervention, which can be useful for future patient-specific predictions of a surgical outcome.

• Computer simulation
• Gastric resection
• Duodenal stump
• Billroth II
• Pressure distribution

• GASTRECTOMY/history

• Gastrectomy/history
• Humans