Duodenogastric reflux induced by endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure for gastric neoplasm.
• Distal gastrectomy, especially with antral resections, can lead to excessive duodenogastric reflux (DGR).
• The impact of ESD on DGR, particularly after antral resections, requires investigation.

Purpose of the Study:

• To examine the occurrence and characteristics of DGR following ESD for gastric neoplasms.
• To compare DGR incidence between ESD in the antral versus nonantral stomach.
• To assess the temporal changes in DGR after ESD.

Main Methods:

• A prospective study involving patients undergoing ESD for gastric neoplasm.
• Patients were categorized into antral (lower stomach) and nonantral (upper/middle stomach) groups.
• Gastric juice was analyzed for fasting bile acid concentration (BAC) at baseline, day 1, and 3 months post-ESD.

Main Results:

• A significant interaction between time point and group was observed for BAC levels.
• Fasting BACs were significantly higher on day 1 post-ESD in the antral group compared to the nonantral group.
• In the antral group, BACs increased transiently post-ESD, returning to baseline by 3 months; lesser curvature lesions showed higher BACs.

Conclusions:

• ESD of lesions in the antral lesser curvature can cause a transient, early increase in DGR.
• ESD does not appear to result in long-term DGR.
• This finding suggests ESD may not carry the same long-term carcinogenesis risk associated with DGR post-gastrectomy.