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Long-term effects in bilio-digestive shunts
R Tritapepe1, D Piro, I Damilano
1Cattedra di Chirurgia dell'Apparato Digerente, Università degli Studi di Milano, Italy.
The Italian Journal of Gastroenterology
|October 1, 1993
Summary
Transduodenal sphincteroplasty (TDS) significantly increased duodenogastric reflux (DGR) and bile acids in patients with bile stones. This led to chronic atrophic gastritis and clinical issues in half of the TDS group.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Biliary Surgery
Background:
- Duodenogastric reflux (DGR) is a condition where bile and intestinal contents flow back into the stomach.
- Bile stones often necessitate surgical interventions that can alter normal gastrointestinal anatomy and function.
- Understanding the impact of different surgical techniques on DGR is crucial for patient outcomes.
Purpose of the Study:
- To investigate the incidence and effects of duodenogastric reflux (DGR) after various bilio-digestive bypass surgeries for bile stones.
- To compare the DGR levels and associated gastric pathology across different surgical methods: choledochoduodenostomy (CD), transduodenal sphincteroplasty (TDS), and endoscopic papillotomy (EP).
Main Methods:
- A prospective study involving 10 patients undergoing CD, 8 undergoing TDS, and 10 undergoing EP for bile stones, with 8 controls.
- Duodenogastric reflux (DGR) was quantified using 99mTc-DISIDA scanning.
- Bile acid concentrations in reflux fluid were measured.
- Gastric effects were assessed via gastroduodenoscopy and biopsies.
Main Results:
- Significant increases in DGR and bile acids were observed only in patients who underwent transduodenal sphincteroplasty (TDS) (7/8 patients, p < 0.008).
- Half of the patients in the TDS group (4/8) developed chronic atrophic gastritis and experienced major clinical disorders.
- Choledochoduodenostomy (CD) and endoscopic papillotomy (EP) groups did not show significant increases in DGR or related pathology compared to controls.
Conclusions:
- Transduodenal sphincteroplasty (TDS) is associated with a significant increase in duodenogastric reflux (DGR) and bile acid levels.
- TDS may lead to the development of chronic atrophic gastritis and adverse clinical outcomes in a substantial proportion of patients.
- Careful consideration of surgical technique is warranted to minimize the risk of DGR and its sequelae in patients undergoing surgery for bile stones.