Reflux Esophagitis and Marginal Ulcer After Pancreaticoduodenectomy

Abstract

Our data support the use of Roux-en-Y reconstruction after standard PD but not after PPPD.

Morbidity Among Long-Term Survivors After Pancreatoduodenectomy for Pancreatic Adenocarcinoma

“…12,18 However, the etiology also can be attributed to a lack of reflux of basic biliopancreatic secretions and a lack of vagotomy, as suggested by some studies showing increased rates of marginal ulceration in patients undergoing Roux-en-Y reconstruction versus a jejunal loop. 19,20 In our study, two patients presented with perforation, both after undergoing a classic Whipple with a jejunal loop reconstruction. Two additional patients were found to have post-anastomotic ulcers and were managed medically.…”

Marginal Ulcer Perforation in a Whipple Survivor: A Rare Long-Term Complication

“…This may be due to the diversion of duodenal and pancreatic secretions away from the anastomosis, which is rich in bicarbonate (protective by buffering low pH). Additionally, the bicarbonate output may decrease after PD [9][10][11]. Another factor that may contribute to a higher incidence with Roux-en-Y reconstruction is a lower incidence of H. pylori after single-loop reconstruction due to the alkaline milieu, which is absent with Roux-en-Y reconstruction [9].…”

“…Another factor that may contribute to a higher incidence with Roux-en-Y reconstruction is a lower incidence of H. pylori after single-loop reconstruction due to the alkaline milieu, which is absent with Roux-en-Y reconstruction [9]. Child reconstruction with modified Braun enteroenterostomy leads to a reduced incidence of marginal ulcers [9][10][11].…”

An unusual case of late gastrointestinal bleeding after pancreatoduodenectomy

“…Jejunal muscosa lacks many of the acid-protective mechanisms present in the duodenum such as bicarbonate secretion and mucin synthesis. The incidence of marginal ulcers following pancreaticojejunostomy has been reported to be 9.4% [4]. Diagnosis of marginal ulceration is achieved via visualization with upper endoscopy, and the treatment is usually medical, consisting of lifelong acid suppression with proton-pump inhibitors or histamine (H2) blockers.…”