[Total duodenal diversion in the treatment of complex peptic esophagitis]

Two duodenal diversion was performed in 107 patients with complex peptic oesophagitis (peptic stenosis, Barrett's mucosa, past history of gastro oesophageal surgery). A standard operation included truncular vagotomy, antrectomy and gastro-jejunal anastomosis on a 70 cm Y loop in 68 patients. Technical adaptations were required in 39 patients. Two patient died (pulmonary embolism and duodenal fistula). The operation was successful with stable cure of the oesophagitis at 3 months in 89% of the patients. Post-prandial pHmetry over 3 hours confirmed control of the reflux in 92% of the cases. Anastomotic ulcer occurred in 4 patients who did not have a vagotomy. One complete regression of Barret's oesophagitis was achieved and in 6 other cases the regression was partial. Stenosis improved in all patients except 1, sometimes after 1 or several dilatations. Digestive sequellae, were observed during the first few months after surgery in 27% of the cases. Persistant sequellae were found in 14% of the operation patients after a delay of 36 months. These results suggest that duodenal diversion is a useful treatment for complicated and complex peptic oesophagitis.