Dilation and stasis: a rare but important late complication of jejunal pouch interposition after proximal gastrectomy

Abstract

Jejunal pouch interposition (JPI) after proximal gastrectomy is occasionally chosen due to superiority in terms of food intake volume and prevention of reflux esophagitis early after surgery. Although the early complications have been reported in the literature, the longterm results and late complications of the procedure are not well known. Herein we described a patient who suffered from dilatation and stasis of the interposed jejunal pouch after proximal gastrectomy. Based on two previous cases and the present study, the dilation of the pouch is irreversible, requiring surgical resection of the dilated pouch. Our experience highlights the need for further investigations to elucidate the long-term outcomes of proximal gastrectomy with JPI. IntroductionProximal gastrectomy is occasionally chosen for the treatment of gastric cancer located in the upper one-third of the stomach, with the aim of preserving gastric digestion 1,2) . Treatment efficacy is the prerequisite for this uncommon procedure. A retrospective study of 128 patients with a preoperative diagnosis of early gastric cancer demonstrated that the outcome of proximal gastrectomy reached the standards in terms of tolerability and tumor curability 3) . There are various reconstruction techniques that can be used after proximal gastrectomy, including esophagogastrostomy, jejunal interposition, double tract, and jejunal pouch interposition (JPI). A nationwide survey in Japan revealed that JPI was the most common reconstruction method in only 7% of 154 institutes surveyed; in comparison, 49% of institutes reported esophagogastrostomy as the most common technique 4) . However, to prevent reflux esophagitis, jejunal interposition is generally required when the remnant stomach is less than onethird of the entire stomach 4) . In this context, although it is not frequently performed, the interposition of the jejunum with or without pouch formation remains an important reconstruction option. Moreover, recent studies indicate that the frequency of tumors located in the upper one-third of the stomach is increasing [5][6][7] suggesting that there will also be an increase in the number of patients Abstract Reports suggest that jejunal pouch interposition (JPI) after proximal gastrectomy is superior in terms of food intake volume and prevention of reflux esophagitis early after surgery. However, the long-term results and late complications of the procedure are not well known. This case report describes an excessive pouch dilatation necessitating surgical intervention as a late complication of JPI. The patient was a 62-year-old woman with early gastric cancer who underwent proximal gastrectomy. Gastrointestinal continuity was restored with JPI. The patient's postoperative course was uneventful and follow-up imaging studies showed no signs of tumor recurrence. However, the patient gradually started to experience difficulty eating food and complained of postprandial nausea and vomiting. Contrast radiography of the upper gastrointestinal tract revealed a dilated jejunal po...