Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy.

Aim: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging.

Methods: As a measure of the reservoir function, with a designed diet containing technetium-99m ((99m)Tc), the emptying time of the gastric substitute was evaluated using a (99m)Tc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a gamma camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared.

Results: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86 +/- 6.43 min) was far closer to normal, significantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07 +/- 15.77 min, P = 0.002) and P type esophagojejunal anastomosis (27.88 +/- 6.07 min, P = 0.001) methods. The half-emptying actual curve and fitting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches.

Conclusion: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.