Abstract
Background
Reducing food residue by proper preparation methods before endoscopy after distal gastrectomy can increase the quality of examination and decrease patient discomfort. We evaluated the risk factors for food residue and proper methods of preparation for endoscopy after distal gastrectomy.
Methods
Follow-up endoscopy with questionnaires was performed on 1,001 patients who underwent distal gastrectomy at Asan Medical Center between December 2010 and July 2011.
Results
Endoscopic examination failed in 94 patients (9.4 %) as a result of large amounts of food residue. Rates of failure were significantly higher in patients who ate a regular diet rather than a soft diet at last dinner before examination (13.9 vs. 6.1 %, p = 0.050), and in those who ate lunch rather than not eating lunch on the day before examination (14.6 vs. 7.7 %, p = 0.020). Multivariate analysis showed that the rate of failed examination was lower in patients who had a history of abdominal surgery (p = 0.011), those who ate a soft (p < 0.001) or liquid (p = 0.003) diet as a last meal rather than a regular diet, those who underwent Billroth I rather than Billroth II reconstruction (p = 0.035), patients with longer fasting time (p = 0.009), and those with a longer gastrectomy-to-endoscopy time interval (p < 0.001).
Conclusions
Patients who undergo follow-up endoscopy after surgery should fast more than 18 h and ingest a soft or liquid diet on the day before examination.
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References
Ahn JY, Jung HY, Choi KD, Choi JY, Kim MY, Lee JH, Choi KS, Kim do H, Song HJ, Lee GH, Kim JH, Park YS (2011) Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 74:485–493
Choi KS, Jung HY, Choi KD, Lee GH, Song HJ, Kim do H, Lee JH, Kim MY, Kim BS, Oh ST, Yook JH, Jang SJ, Yun SC, Kim SO, Kim JH (2011) EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 73:942–948
Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225
Thorban S, Bottcher K, Etter M, Roder JD, Busch R, Siewert JR (2000) Prognostic factors in gastric stump carcinoma. Ann Surg 231:188–194
Ohashi M, Katai H, Fukagawa T, Gotoda T, Sano T, Sasako M (2007) Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg 94:92–95
Huguier M, Ferro L, Barrier A (2002) Early gastric carcinoma: spread and multicentricity. Gastric Cancer 5:125–128
Bearzi I, Ranaldi R (1986) Multifocal early gastric cancer: morphology and histogenesis. Pathol Res Pract 181:144–147
Kosaka T, Miwa K, Yonemura Y, Urade M, Ishida T, Takegawa S, Kamata T, Ooyama S, Maeda K, Sugiyama K et al (1990) A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy. Cancer 65:2602–2605
Otsuji E, Kuriu Y, Ichikawa D, Okamoto K, Hagiwara A, Yamagishi H (2005) Clinicopathologic characteristics and prognosis of synchronous multifocal gastric carcinomas. Am J Surg 189:116–119
Rider JA, Foresti-Lorente RF, Garrido J, Puletti EJ, Rider DL, King AH, Bradley SP (1984) Gastric bezoars: treatment and prevention. Am J Gastroenterol 79:357–359
Watanabe H, Adachi W, Koide N, Yazawa I (2003) Food residue at endoscopy in patients who have previously undergone distal gastrectomy: risk factors and patient preparation. Endoscopy 35:397–401
Jung HJ, Lee JH, Ryu KW, Lee JY, Kim CG, Choi IJ, Kim YW, Bae JM (2008) The influence of reconstruction methods on food retention phenomenon in the remnant stomach after a subtotal gastrectomy. J Surg Oncol 98:11–14
Cho SB, Yoon KW, Park SY, Lee WS, Park CH, Joo YE, Kim HS, Choi SK, Rew JS (2009) Risk factors for food residue after distal gastrectomy and a new effective preparation for endoscopy: the water-intake method. Gut Liver 3:186–191
Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, Sano T, Katai H (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89
De Silva AP, Amarasiri L, Liyanage MN, Kottachchi D, Dassanayake AS, de Silva HJ (2009) One-hour fast for water and six-hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort. J Gastroenterol Hepatol 24:1095–1097
De Silva AP, Niriella MA, Perera H, Aryasingha S, Kalubovila U, Manchanayake J, Dassanayake AS, Devanarayana NM, Pathmeswaran A, de Silva HJ (2010) Is a six hour fast after a rice meal sufficient before upper gastrointestinal endoscopy? Scand J Gastroenterol 45:987–991
Faigel D (2006) SAGES co-endorsed ASGE guidelines. Preparation of patients for gastrointestinal endoscopy. http://www.asges.org. Accessed 12 June 2008
Diettrich NA, Gau FC (1985) Postgastrectomy phytobezoars—endoscopic diagnosis and treatment. Arch Surg 120:432–435
Camilleri M, Malagelada JR, Brown ML, Becker G, Zinsmeister AR (1985) Relation between antral motility and gastric emptying of solids and liquids in humans. Am J Physiol 249:G580–G585
Disclosures
J. Y. Ahn, H.-Y. Jung, S. E. Bae, J. H. Jung, J. Y. Choi, M.-Y. Kim, J. H. Lee, K.-S. Choi, D. H. Kim, K. D. Choi, H. J. Song, G. H. Lee, J.-H. Kim, and S. Han have no conflicts of interest or financial ties to disclose.
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Ahn, J.Y., Jung, HY., Bae, S.E. et al. Proper preparation to reduce endoscopic reexamination due to food residue after distal gastrectomy for gastric cancer. Surg Endosc 27, 910–917 (2013). https://doi.org/10.1007/s00464-012-2532-9
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DOI: https://doi.org/10.1007/s00464-012-2532-9