Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth Ⅱ gastrectomy

AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP attempts.In all cases,the ERCP procedures were started using a duodenoscope.If intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success rate.RESULTS:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent DBE-ERCP.The DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully treated.One patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by biopsy.There were no complications related to the DBE.The overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.

Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth Ⅱ gastrectomy

AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.

远端胃大部切除术中BillrothⅡ+Braun吻合对进展期胃癌术后营养状况及并发症的影响

目的探讨BillrothⅡ+Braun吻合应用于远端胃大部切除术中对进展期胃癌患者的营养状况及并发症的影响。方法选择2017年1月至2022年12月在南京医科大学第四附属医院接受远端胃大部切除术且完成6个月随访的95例进展期胃癌患者作为研究对象,将其中采用BillrothⅡ+Braun吻合的45例患者作为观察组;采用BillrothⅡ吻合的50例患者作为对照组。比较两组患者手术时间、术中出血量、术后下床活动时间、首次肛门排气时间、住院时间、并发症发生情况及术后3、6个月血清总蛋白、白蛋白及血红蛋白水平。结果两组患者手术时间、术中出血量、术后下床活动时间、首次肛门排气时间及住院时间比较,差异无统计学意义(P>0.05);观察组患者的术后3、6个月血清总蛋白、白蛋白、血红蛋白水平均显著高于对照组(P<0.05);观察组患者近期并发症及远期并发症发生率均显著低于对照组(P<0.05)。结论应用BillrothⅡ+Braun吻合可有效改善进展期胃癌远端胃大部切除术患者术后营养状况,降低术后近期及远期并发症发生率。

腹腔镜下胃切除术中BillrothⅡ式伴布朗式吻合术的应用效果研究

目的:分析腹腔镜下胃切除术中BillrothⅡ式伴布朗式吻合术的应用效果。方法:研究开展时间为2020年8月至2022年7月,从黔东南州人民医院收治的胃癌患者中随机筛选84例进行研究,随机分为两组,各42例。两组均采取腹腔镜下胃切除术治疗,其中对照组术中采取BillrothⅡ式吻合操作,观察组术中采取BillrothⅡ式伴布朗式吻合操作,对比两组的手术及术后恢复指标、术后早期并发症发生率及远期疗效。结果:两组的手术时间、消化道重建耗时、术中出血量、术后排气时间、住院时间相比差异不显著(P>0.05)。在术后早期并发症方面,观察组腹泻、反流、肠梗阻的发生率均显著低于对照组(P<0.05),两组吻合口瘘、胃瘫综合征的发生率相比差异不显著(P>0.05)。术后6个月,观察组中Visick分级Ⅰ级患者的占比显著高于对照组(P<0.05),两组中Visick分级Ⅱ级、Ⅲ级、Ⅳ级患者的占比相比差异不显著(P>0.05)。结论:在腹腔镜下胃切除术中,采取BillrothⅡ式伴布朗式吻合术能显著降低患者术后腹泻、反流、肠梗阻的发生率,提高远期疗效,且不会增加手术难度,对术中出血量及手术时间影响不大。

挂线自膨式金属支架在BillrothⅡ式胃大部切除术后输出梗阻治疗中的应用

目的介绍一种挂线自膨式金属支架内镜下置入处理胃大部切除术后输出梗阻的方法并探讨其应用效果。方法回顾华中科技大学同济医学院附属协和医院2018年12月至2021年8月4例胃肿瘤手术后输出梗阻病人行内镜下挂线支架治疗的临床过程并分析预后效果。结果4例出现输出梗阻症状的胃大部切除术后病人中,1例为吻合口狭窄,1例内镜下见输出袢扭转致吻合口处肠腔变窄,1例为吻合口位于小弯侧近贲门造成输出袢明显成角,1例为距吻合口处约3 cm处肠腔狭窄不通畅,均存在结构性异常。4例采取内镜下挂线支架治疗,支架置入4例均成功完成,支架置入后梗阻症状立即改善,造影示造影剂排空通畅。3例吻合口处异常经支架置入处理后梗阻症状未复发,1例输出肠袢梗阻经3次支架处理,拔除支架后梗阻症状再发,经再次手术处理解决。4例病人住院及随访期间未出现支架相关不良事件。结论对于BillrothⅡ式胃大部切除术后吻合口及输出袢狭窄、成角、轻度扭转等原因造成的梗阻,采用内镜下挂线自膨式金属支架置入处理,可以立即解除梗阻症状,部分维持一定时间后取出支架可完全解除梗阻。挂线支架作为传统保守治疗方法的替代或补充,可显著减少消化液丢失,尽快恢复肠内营养,减少不必要的非计划二次手术。

Laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer (Billroth Ⅱ anastomosis)

Laparoscopic radical gastrectomy has been increasingly applied in China. However, how to reduce surgery-related trauma, shorten operative time and achieve the long-term prognosis equal to the conventional open surgery is still hot research topics. Along with the change in learning curve and the optimization of endoscopic techniques, laparoscopic lymph node dissection can achieve or even exceed the extent that can be achieved in open surgery. Therefore, it has gradually replaced the conventional digestive tract reconstruction using an auxiliary incision. By completing the laparoscopic digestive tract reconstruction with EndoGIA, we describe the laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer （Billroth Ⅱ anastomosis）.

Comparison between laparoscopic uncut Roux-en-Y and Billroth Ⅱ with Braun anastomosis after distal gastrectomy:A meta-analysis

BACKGROUND Conventional Billroth Ⅱ(BⅡ) anastomosis after laparoscopic distal gastrectomy(LDG) for gastric cancer(GC) is associated with bile reflux gastritis, and Roux-enY anastomosis is associated with Roux-Y stasis syndrome(RSS). The uncut Rouxen-Y(URY) gastrojejunostomy reduces these complications by blocking the entry of bile and pancreatic juice into the residual stomach and preserving the impulse originating from the duodenum, while BⅡ with Braun(BB) anastomosis reduces the postoperative biliary reflux without RSS. Therefore, the purpose of this study was to compare the efficacy and safety of laparoscopic URY with BB anastomosis in patients with GC who underwent radical distal gastrectomy.AIM To evaluate the value of URY in patients with GC.METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, and VIP Database for Chinese Technical Periodicals(VIP) were used to search relevant studies published from January 1994 to August 18, 2021. The following databases were also used in our search: Clinicaltrials.gov, Data Archiving and Networked Services, the World Health Organization International Clinical Trials Registry Platform Search Portal(https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal), the reference lists of articles and relevant conference proceedings in August 2021. In addition, we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com). We cited highquality references using its results analysis functionality. The methodological quality of the eligible randomized clinical trials(RCTs) was evaluated using the Cochrane Risk of Bias Tool, and the non-RCTs were evaluated using the Newcastle-Ottawa scale. Statistical analyses were performed using Review Manager(Version 5.4).RESULTS Eight studies involving 704 patients were included in this meta-analysis. The incidence of reflux gastritis [odds ratio = 0.07, 95% confidence interval(CI): 0.03-0.19, P < 0.00001] was significantly lower in the URY group than in the BB group. The pH of the postoperative gastric fluid was lower in the URY group than in the BB group at 1 d [mean difference(MD) =-2.03, 95%CI:(-2.73)-(-1.32),P < 0.00001] and 3 d [MD =-2.03, 95%CI:(-2.57)-(-2.03), P < 0.00001] after the operation. However,no significant difference in all the intraoperative outcomes was found between the two groups.CONCLUSION This work suggests that URY is superior to BB in gastrointestinal reconstruction after LDG when considering postoperative outcomes.

毕Ⅱ式联合Braun与单纯毕Ⅱ式吻合在腹腔镜远端胃癌根治术中疗效比较的Meta分析

目的系统评价BillrothⅡ式与BillrothⅡ式联合Braun吻合重建术在腹腔镜远端胃癌根治术中的临床疗效差异。方法计算机检索CNKI、VIP、万方数据库、PubMed、Embase、Web of Science等,收集国内外公开发表关于两种消化道重建方式在腹腔镜远端胃癌根治术中比较的临床应用研究。检索时限为2000年1月至2022年10月。对纳入的临床研究进行质量评价及数量提取,并采用Cochrane协作网提供的RevMan5.3统计软件进行Meta分析。结果共纳入9项符合标准的研究,共1483例患者。Meta分析结果显示:在腹腔镜远端胃癌根治术中使用单纯BillrothⅡ式吻合手术时间及消化道重建时间短、术中出血量少,但使用BillrothⅡ联合Braun吻合住院时间短、近期总并发症少、远期反流性疾病少、远期营养状况好,差异均有统计学意义(P<0.05)。而淋巴结清扫数量、首次排气排便时间及部分短期并发症,差异无统计学意义(P>0.05)。结论腹腔镜远端胃癌根治术中,与单纯BillrothⅡ吻合相比,应用BillrothⅡ式联合Braun重建消化道,虽延长手术时间并增加术中出血量,但能减少患者术后近、远期并发症,减少术后住院时间,改善患者远期营养状况,临床应用具有一定优势。

Does the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopic-assisted distal gastrectomy benefit patients?

BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because it is believed to benefit patients.However,studies are needed to confirm that.AIM To identify whether the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019.Clinical data of the patients were collected,and 93 of the 143 patients were followed up.These 93 patients were divided into two groups:Group 1(Billroth Ⅱ reconstruction,33 patients);and Group 2(Billroth Ⅱ reconstruction combined with Braun anastomosis,60 patients).Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications(6.1%vs 6.7%,P=0.679),anal exhaust time or blood loss.The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2(68.2%vs 51.7%,P=0.109).The followup European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well.Group 1 had a shorter operating time than Group 2 on average(234.6 min vs 262.0 min,P=0.017).CONCLUSION Combined with Billroth Ⅱ reconstruction,Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis.Whereas in this study,the prevalence of reflux gastritis showed no significant difference,leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money,simple Billroth Ⅱ reconstruction should be widely applied.

入口上提的改良Billroth Ⅱ+Brown吻合在腹腔镜远端胃癌根治术中的应用价值

目的:比较入口上提的改良BillrothⅡ+Brown吻合术与传统BillrothⅡ+Brown吻合术在全腔镜下远端胃癌根治性切除术中的临床应用价值。方法:回顾分析2020年1月至2022年3月收治的182例胃癌患者的临床资料,其中92例术中行入口上提的改良BillrothⅡ+Brown吻合术(观察组),90例行传统BillrothⅡ+Brown吻合术(对照组),对比分析两组患者术中情况(包括手术时间、消化道重建时间、术中出血量、淋巴结清扫数量)、术后早期肠道功能恢复情况(包括术后首次排气时间及首次下床活动时间)、并发症(包括术后十二指肠残端漏,输入袢、输出袢梗阻等)及术后半年内随访相关指标(包括胆汁反流、反流性胃炎等)。结果:两组手术时间、消化道重建时间、术中出血量、淋巴结清扫数量差异无统计学意义,观察组术后早期排气时间[(2.60±0.70)d vs.(3.10±1.20)d]、术后首次下床活动时间[(3.20±1.50)d vs.(5.10±1.30)d]早于对照组(P<0.05)。在术后并发症方面,观察组输入袢梗阻发生率(1.09%vs.7.78%)、总并发症发生率(6.52%vs.12.22%)低于对照组(P<0.05),两组在吻合口漏、输出袢梗阻等方面差异无统计学意义。在远期并发症方面,对照组胆汁反流、胃炎更严重,差异有统计学意义,两组Clavien-Dindo术后分级差异无统计学意义。结论:入口上提的改良BillrothⅡ+Brown吻合方式是安全、可行的,在术后肠道功能早期恢复、减少术后并发症、改善术后生活质量方面较传统吻合方式更具优势,具有较高的临床应用价值,值得推广。

Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients

BACKGROUND The surgeon performing a distal gastrectomy,has an arsenal of reconstruction techniques at his disposal,Billroth II among them.Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II,in terms of survival,with no impact on postoperative morbidity and mortality.AIM To compare Billroth II vs Billroth II and Braun following distal gastrectomy,regarding their postoperative course.METHODS Patients who underwent distal gastrectomy during 2002-2021,were separated into two groups,depending on the surgical technique used(Billroth II:74 patients and Billroth II and Braun:28 patients).The daily output of the nasogastric tube(NGT),the postoperative day that NGT was removed and the day the patient started per os feeding were recorded.Postoperative complications were at the same time noted.Data were then statistically analyzed.RESULTS There was difference in the mean NGT removal day and the mean start feeding day.Mean total postoperative NGT output was lower in Braun group(399.17 mL vs 1102.78 mL)and it was statistically significant(P<0.0001).Mean daily postoperative NGT output was also statistically significantly lower in Braun group.According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group,while 9 patients who underwent Christodoulidis G et al.Billroth II and Braun compared with Billroth II WJM https://www.wjgnet.com 2 March 20,2024 Volume 14 Issue 1 Billroth II and Braun anastomosis were presented with the same conditions(P<0.05).CONCLUSION There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux,alkaline gastritis and NGT output.

胃癌Billroth Ⅱ式胃切除术对合并2型糖尿病患者的治疗价值

目的探讨胃癌BillrothⅡ式胃切除术对合并2型糖尿病患者糖代谢的影响。方法回顾性观察7例体重指数(BMI)<35kg/m2合并2型糖尿病的病人因胃癌接受BillrothⅡ式胃切除手术前后血糖控制情况以及糖尿病治疗的变化。结果7例均成功完成了根治性BillrothⅡ式胃切除术,4例行腹腔镜手术,3例行开腹手术。术后未发生严重并发症。术前空腹血糖(FPG)6.6～9.0mmol/L,平均8.1mmol/L;糖化血红蛋白(HbA1c)6.8%～9.5%,平均7·8%。术后1～8个月复查FPG4.8～7.9mmol/L,平均6.4mmol/L;HbA1c5.5%～7.2%,平均6.3%。据美国糖尿病协会(ADA)糖尿病疗效判断标准,4例治愈,3例改善。结论胃癌BillrothⅡ式胃切除术可治疗胃癌患者合并的2型糖尿病。

小切口胆管十二指肠残端吻合治疗胃BillrothⅡ术后胆管结石

目的探讨胃BillrothⅡ式术后胆管结石的诊治方法。方法先进行ERCP检查明确胆管结石,再采用右肋缘下5～6 cm微小切口开腹做胆管十二指肠残端吻合术治疗。结果 36例小切口胆总管十二指肠残端吻合术顺利,无并发症。结论胃BillrothⅡ式术后胆管结石ERCP成功率较高并有实用价值,进行小切口胆总管十二指肠残端吻合术临床疗效好。

胃BillrothⅡ式术后肝胆管结石219例诊治分析

目的探讨胃BillrothⅡ式术后肝胆管结石的临床特点。方法胃BillrothⅡ式术后肝胆管结石患者219例中,130例单一抗感染治疗;74例进行逆行胰胆管造影(ERCP)后,34例经内镜乳头括约肌切开(EST)、4例经内镜乳头气囊扩张术(EPBD)取石、36例行小切口胆总管十二指肠残端吻合术;15例急性重症胆管炎手术引流。结果全组137例ERCP成功109(79.6%)例,失败28(20.4%)例。130例单一抗感染治疗好转出院;38例EST取石治疗,成功31(81.6%)例,并发消化道大出血4例;36例小切口胆总管十二指肠残端吻合术和15例急诊手术者均顺利治愈出院。结论胃BillrothⅡ式术后肝胆管结石急性期多数保守治疗能缓解,施行EST治疗成功率较高并有临床实用价值,进行小切口胆总管十二指肠残端吻合术临床效果较好。

非离断式Roux-en-Y吻合与BillrothⅡ式吻合在腹腔镜远端胃癌根治术中比较的meta分析

目的:系统评价非离断式Roux-en-Y吻合术与BillrothⅡ式吻合术在腹腔镜远端胃癌根治术中的临床疗效。方法:检索PubMed、Embase、Cochrane图书馆、CBM、VIP、CNKI及万方数据等数据库,收集国内外公开发表的关于两种消化道重建方式在腹腔镜远端胃癌根治术中对比的临床研究,检索时限为建库至2019年10月。对纳入的文献进行资料提取与质量评价,应用RevMan 5.3软件进行meta分析。结果:最终纳入9项研究,共900例患者。meta分析结果显示,在腹腔镜远端胃癌根治术中应用非离断式Roux-en-Y吻合术后排气时间、首次进流质饮食时间及住院时间短(WMD=-0.29,95%CI-0.44^-0.13,P=0.0002;WMD=-0.41,95%CI-0.66^-0.15,P=0.002;WMD=-0.85,95%CI-1.23^-0.47,P<0.00001),术后近期胃排空障碍、远期胆汁反流及反流性胃炎发生率较低(OR=0.41,95%CI 0.19~0.88,P=0.02;OR=0.06,95%CI 0.02~0.19,P<0.00001;OR=0.14,95%CI 0.05~0.42,P=0.0003),两组手术时间、术中消化道重建时间、术中出血量及远期营养状况差异无统计学意义。结论:腹腔镜远端胃癌根治术中应用非离断式Roux-en-Y吻合术是安全、可行的,具有较好的近、远期临床疗效,可有效降低术后近期胃排空障碍、远期胆汁反流及反流性胃炎发生率,临床应用具有一定优势。

胃镜治疗Billroth Ⅱ式胃大部切除术后输出襻嵌顿性胃石1例

病例：患者女性,68岁,因“上腹部饱胀不适伴呕吐1周,黑便2 d”于2015-11-22入院。入院前1周患者无明显诱因出现上腹部饱胀不适,进食后明显,伴恶心呕吐,呕吐物为胃内容物,无呕血,呕吐后症状短暂好转。入院前2 d出现黑便,1次/d,每次量约50~100 g,无头昏乏力。起病后精神可,无明显体质量下降。20年前曾行“胃淋巴瘤切除术”。1年前胃镜检查诊断：吻合口炎,残胃炎。

Billroth-Ⅱ与Roux-en-Y重建消化道对高龄胃癌患者术后中长期生存质量的影响

目的:探讨Billroth-Ⅱ与Roux-en-Y术式重建消化道对高龄患者远期生存质量的影响。方法:122例70岁以上行远端胃癌根治术患者,采用毕-Ⅱ术式的65例作为毕-Ⅱ组、采用R-Y术式的57例作为R-Y组;于消化道重建术后1年,比较2组患者胃肠道症状评分、吻合口2 cm处的胃炎程度、生活质量(QOL)评分、营养风险指数(NRI)及血清转铁蛋白(TFN)、前白蛋白(PA)、血浆白蛋白(ALB)水平;采用Logistic多变量回归分析患者术前体质量指数(BMI)、肿瘤位置、重建方式及吻合方式对术后发生胃肠道症状风险的影响因素。结果:术后1年2组患者胃肠道症状评分、NRI及血清TFN、PA、ALB水平比较,差异无统计学意义(P>0.05);R-Y组患者吻合口2 cm处重度胃炎发生率(38.6%)显著低于毕-Ⅱ组(56.9%)、QOL评分显著高于毕-Ⅱ组,差异有统计学意义(P<0.05);Logistic多变量回归分析显示,术前BMI(<25 kg/m 2、≥25 kg/m 2)、肿瘤位置(胃窦、胃体)、重建方法(毕-Ⅱ、R-Y)及吻合方式(手工、器械)均不是影响术后发生胃肠道症状风险的独立因素。结论:行远端胃癌根治术的高龄患者,R-Y术式的中长期疗效优于毕-Ⅱ术式。