• 대한한방내과학회지
• /
• 제41권6호
• /
• pp.1162-1171
• /
• 2020

Objectives: The aim of this study was to determine the therapeutic effects of a traditional Korean treatment on the symptom improvement and loss of bile juice in cases of functional dyspepsia of gastric dysmotility complicated by bile juice reflux. Methods: Dyspeptic symptoms, gastric motility (electrogastrography and bowel sound analysis), and gastric mucosa (gastroendoscopy) were evaluated. The treatment consisted of Banwhasashim-tang (extract) used as a herbal drug. Both ST36 electrical stimulation and simple immersion stimulation of CV11, 12, and 13 in the abdomen were also applied. Results: Dyspeptic symptoms, including a foreign body sensation in the throat, indigestion, and upper abdominal pain, were all relieved by the treatment and gastric myoelectrical activity and gastric pyloric function were improved. Bile juice disappeared from the gastric mucosa. Conclusion: The traditional Korean treatment was effective at relieving dyspeptic symptoms and bile juice reflux by improving the pyloric sphincter function.

• 핵의학기술
• /
• 제14권2호
• /
• pp.17-20
• /
• 2010

간담도 스캔은 간세포와 담낭의 기능정도 및 담도계의 폐쇄여부를 알 수 있는 검사법이다. 또한 위부분절제술 후에 증가하는 위-담즙 역류는 담즙 역류성 위염의 주요 원인으로 알려져 있다. 본 연구는 위부분절제술 환자의 간담도 스캔에서 위-담즙역류가 관찰되어 촬영방법에 따른 역류시기와 역류지표를 알아보고자 한다. 본원 핵의학과에 2008년 10월부터 2009년 1월까지 간담도 스캔을 시행한 환자 중 위부분절제술을 한 환자 72명(남자: 52명, 여자: 20명, 연령범위: 31-77세, 평균연령: $60.5{\pm}7$세)을 대상으로 하였다. $^{99m}Tc$-mebrofenin 185 MBq/0.5 cc를 환자의 전주정맥에 주사 5분 후 바로 누운자세에서 전면상 30 kcounts를 획득하고, time setting으로 우측면상, $45^{\circ}$ 좌전사 위상을 획득하였다. 동일한 방법으로 30분, 60분, 90분, 지방식 후 120분 영상을 획득하였다. 위-담즙역류가 일어난 환자의 경우 30분 전면상, 좌전사위상에서 liver, GB, CBD의 ROI를 그리고, 이후 영상들에서 위 역류 부분의 시간 별, 자세 별 관심영역을 그렸다. 그리고 그에 따른 역류지표 구하였다. 72명의 위부분절제술 환자 중 위-담즙역류가 40명(55.6%)의 환자에서 일어났으며, 30분 영상에서 1명, 60분 영상에서 7명, 90분 영상에서 4명, 지방식 후 영상에서 28명이었다. 시간 별 위-담즙역류가 최고치는 60분 영상에서 6명, 90분 영상에서 2명, 지방식 후 영상에서 32명으로 보였다. 전면상의 역류지표 0.85-23.36%(평균: 6.53%), 좌전사위상의 역류지표 1-29.13%(평균: 8.89%)이었다. 육안평가로는 26명(65%)이 전면상보다 좌전사위상의 위-담즙역류가 더 잘 구분되어 보였다. 위부분절제술 환자의 간담도 스캔에서 위-담즙역류가 50% 이상 일어나는 것을 알 수 있고, 음식물을 섭취한 후 위-담즙역류가 가장 잘 일어나는 것을 알 수 있었다. 위-담즙역류가 일어나는 경우 장과 위의 중첩을 줄여주는 좌전사위상을 촬영하고 환자마다 그에 따른 시간대의 위-담즙 역류 지표를 제공함으로써 임상에서 간담도 스캔 목적 이외의 도움이 될 것이라 생각된다.

• Journal of Gastric Cancer
• /
• 제14권4호
• /
• pp.229-237
• /
• 2014

Purpose: Laparoscopic distal gastrectomy (LDG) is a well-established procedure for the treatment of early gastric cancer. Several reconstruction methods can be adopted after LDG according to tumor characteristics and surgeon preference. This study aimed to compare the remnant gastric functions after different reconstructions. Materials and Methods: In total, 221 patients who underwent LDG between March 2005 and October 2013 were reviewed retrospectively. The patients were classified into four groups based on the reconstructive procedure: Billroth I (BI) anastomosis, Billroth II (BII) with Braun anastomosis, Roux-en-Y (RY) reconstruction, or uncut RY reconstruction. Patient demographics, surgical outcomes, and postoperative endoscopic findings were reviewed and compared among groups. Results: Endoscopic evaluations at $11.8{\pm}3.8$ months postoperatively showed less frequent gastritis and bile reflux in the remnant stomach in the RY group compared to the BI and BII groups. There was no significant difference in the gastric residue among the BI, BII, and RY groups. The incidence of gastritis and bile reflux in the uncut RY group was similar to that in the RY group, while residual gastric content in the uncut RY group was significantly smaller and less frequently observed than that in the RY group (5.8% versus 35.3%, P=0.010). Conclusions: RY and uncut RY reconstructions are equally superior to BI and BII with Braun anastomoses in terms of gastritis and bile reflux in the remnant stomach. Furthermore, uncut RY reconstruction showed improved stasis compared to conventional RY gastrojejunostomy. Uncut RY reconstruction can be a favorable reconstructive procedure after LDG.

• Journal of Gastric Cancer
• /
• 제11권4호
• /
• pp.219-224
• /
• 2011

Purpose: The Roux en Y method has rarely been performed due to longer operation time and high risk of complication, despite several merits including prevention of bile reflux. We conducted a retrospective review of the result of Roux en Y reconstruction using two circular staplers after subtotal gastrectomy. Materials and Methods: From December 2008 to May 2009, a total of 26 patients underwent Roux en Y reconstruction using two circular staplers after subtotal gastrectomy, and seventy-two patients underwent Billroth-I reconstruction. Roux en Y anastomosis was performed using two circular staplers without hand sewing anastomosis. We compared clinicopathologic features and surgical outcomes between the two groups. All patients underwent gastrofiberscopy between six and twelve months after surgery to compare the bile reflux. Results: No significant differences in clinicopathologic findings were observed between the two groups, except for the rate of minimal invasive surgery (P=0.004) and cancer stage (P=0.002). No differences in the rate of morbidity (P=0.353) and admission duration (P=0.391) were observed between the two groups. Gastrofiberscopic findings showed a significant reduction of bile reflux in the remnant stomach in the Roux en Y group (P=0.019). Conclusions: When compared with Billroth-I reconstruction, Roux en Y reconstruction using the double stapler technique was found to reduce bile reflux in the remnant stomach without increasing postoperative morbidity. Based on these results, we planned to begin a randomized controlled clinical trial for comparison of Roux en Y reconstruction using this method with Billroth-I anastomosis.

• Journal of Gastric Cancer
• /
• 제17권3호
• /
• pp.255-266
• /
• 2017

Purpose: Although Roux-en-Y (R-Y) reconstruction after distal gastrectomy has several advantages, such as prevention of bile reflux into the remnant stomach, it is rarely used because of the technical difficulty. This prospective randomized clinical trial aimed to show the efficacy of a novel method of R-Y reconstruction involving the use of 2 circular staplers by comparing this novel method to Billroth-I (B-I) reconstruction. Materials and Methods: A total of 118 patients were randomly allocated into the R-Y (59 patients) and B-I reconstruction (59 patients) groups. R-Y anastomosis was performed using two circular staplers and no hand sewing. The primary end-point of this clinical trial was the reflux of bile into the remnant stomach evaluated using endoscopic and histological findings at 6 months after surgery. Results: No significant differences in clinicopathological findings were observed between the 2 groups. Although anastomosis time was significantly longer for the patients of the R-Y group (P<0.001), no difference was detected between the 2 groups in terms of the total surgery duration (P=0.112). Endoscopic findings showed a significant reduction of bile reflux in the remnant stomach in the R-Y group (P<0.001), and the histological findings showed that reflux gastritis was more significant in the B-I group than in the R-Y group (P=0.026). Conclusions: The results of this randomized controlled clinical trial showed that compared with B-I reconstruction, R-Y reconstruction using circular staplers is a safe and feasible procedure. This clinical trial study was registered at www.ClinicalTrials.gov (registration No. NCT01142271).

• Journal of Gastric Cancer
• /
• 제20권3호
• /
• pp.337-343
• /
• 2020

Distal gastrectomy with Billroth I or II reconstruction may cause duodenogastroesophageal reflux (DGER), thereby resulting in digestive or respiratory symptoms. The mainstay of treatment is medication with proton pump inhibitors. However, these drugs may have limited effects in DGER. Laparoscopic fundoplication has been proven to be highly effective in treating gastroesophageal reflux disease (GERD), but it cannot be performed optimally for GERD that develops after gastrectomy. We report the case of a 72-year-old man with a history of distal gastrectomy and Billroth I anastomosis due to early gastric cancer. GERD due to bile reflux occurred after surgery and was refractory to medical therapy. The patient underwent Roux-en-Y conversion from Billroth I gastroduodenostomy and hiatal hernia repair with only cruroplasty. Fundoplication was not performed. His symptoms improved significantly after the surgery. Therefore, laparoscopic hiatal hernia repair and Roux-en-Y conversion can be an effective surgical procedure to treat medically refractory DGER after Billroth I gastrectomy.

• Journal of Gastric Cancer
• /
• 제20권1호
• /
• pp.72-80
• /
• 2020

Purpose: Proximal gastrectomy (PG) is a function-preserving surgery in cases of proximally located early-stage gastric cancer. Because gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall to the proximal part of the anterior stomach wall to produce an anti-reflux mechanism; we named this the SPADE operation. This study aimed to show demonstrate the clinical outcomes of the SPADE operation and compare them to those of previous PG cases. Materials and Methods: Case details of 56 patients who underwent PG between January 2012 and March 2018 were retrospectively reviewed: 30 underwent conventional esophagogastrostomy (CEG) anastomosis using a circular stapler, while 26 underwent the SPADE operation. Early postoperative clinical outcome-related reflux symptoms, endoscopic findings, and postoperative complications were compared in this case-control study. Results: Follow-up endoscopy showed more frequent reflux esophagitis cases in the CEG group than in the SPADE group (30% vs. 15.3%, P=0.19). Similarly, bile reflux (26.7% vs. 7.7%, P=0.08) and residual food (P=0.01) cases occurred more frequently in the CEG group than in the SPADE group. In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while 3 patients (10%) had severe reflux symptoms. In the SPADE group, 3 patients (11.5%) had mild reflux symptoms, while 1 had severe reflux symptoms (absolute difference, 31.8%; 95% confidence interval, 1.11-29.64; P=0.01). Conclusions: A novel modified EG, the SPADE operation, has the potential to decrease gastroesophageal reflux following a PG.

• 대한후두음성언어의학회지
• /
• 제18권2호
• /
• pp.113-117
• /
• 2007

Although the prevalence of laryngopharyngeal reflux (LPR) is presumed to be very high, basic researches on LPR have not been active so far. This is a review of present status and prospect of researches on LPR to help readers' understanding of current trend on LPR research. In vitro and in vivo researches on acid/pepsin, intercellular junctions, bile juice, carbonic anhydrase, cytokines, and Helicobacter pylori were discussed. Considering that quality of life is getting more important in accordance with longer life span and that a fair proportion of LPR patients do not respond to conventional therapy, researches on pathogenesis and pathophysiology of treatment measures are necessary and it is anticipated for more and more researchers to concern themselves in basic research on LPR in the future.

• 대한핵의학회지
• /
• 제29권3호
• /
• pp.313-318
• /
• 1995

통상적인 Tc-99m DISIDA 스캔도중 우연하게 위장역류가 발견되는 경우가 있는데 이의 임상적 의의를 알아보고자 1991년 12월부터 1995년 6월까지 충남대학교병원에서 통상적인 Tc-99m DISIDA 스캔을 시행한 1,553명의 환자들중 우연하게 위장부위로 방사능역류를 보인 36명의 환자들을 대상으로 후향적으로 이러한 환자들의 검사당시 임상상을 알아보았다. 1) 연구기간동안 시행한 Tc-99m DISIDA 스캔상 위장 역류는 2.3%에서 발견되었다. 2) 위장역류를 보인 대상환자중 위장관 및 담도계에 수술을 받은 과거 병력이 있는 경우는 19% 이었으며 역류가 없었던 환자들에서보다 의미있게 많았다(p<0.01). 3) 역류가 발견되는 시점은 Tc-99m DISIDA 정맥주사 후 30분에서 60분 사이가 50%로 가장 많았으며 60분에서 90분 사이가 23% 이었다. 4) 위장 역류를 보인 환자중 87%에서 위내시경 검사상 위염, 위궤양, 십이지장궤양, 위암등의 병변을 보였다. 이상에서 저자들은 Tc-99m DISIDA 스캔상 위-십이지장 역류를 보이는 경우는 역류가 없는 경우보다 위장관이나 담도계에 수술을 받은 병력이 있는 경우가 의미있게 많았으며 이들 중 상당수가 위-십이지장에 질환을 가지고 있음을 알 수 있었다.

• Advances in pediatric surgery
• /
• 제4권2호
• /
• pp.100-109
• /
• 1998

The anomalous pancreaticobiliary duct union (APBDU) might cause the formation of choledochal cyst and malignancies of hepatopancreaticobiliary system. The purpose of this study is to make an experimental animal model of APBDU similar to that of human. One to two-month-old Mongrel dogs (n=12) were divided into two groups; the control group (n=2) had a sham operation performed, and in the experimental group (n=10) the end of distal ' common bile duct (CBD) was anastomosed to the side of the dorsal pancreatic duct making APBDD. Serum was obtained for chemical analysis on the 10th postoperative day. The dogs were sacrificed at the 5th week (n=3), the 6th week (n=3), the 7th week (n=2), the 8th week (n=2) and the 6th month (n=2) after the experimental surgery. With sacrifice, operative cholangiogram was taken, and bile juice was obtained for chemistry and bacterial culture. The en-bloc specimens of the hepatopancreaticobiliary system were removed for microscopic examination. Serum and bile juice amylase levels were elevated in the experimental group(n=10), but not in the control group(n=2). Operative cholangiograms of control group revealed no evidence of bile duct dilatation.. On the other hand, the bile duct in the experimental group was markedly dilated without any evidence of stenosis at the anastomosis site (n=10). Histologic examination of the hepatopancreaticobiliary system in the experimental group resembled the findings of choledochal cyst in human. The APBDU of this animal model can produce bile duct dilatation by pancreaticobiliary reflux. We think that this animal model can be potentially promising for the research about the APBDU associated hepatopancreaticobiliary diseases.