Alkaline reflux esophagitis after total gastrectomy

Esophagoduodenostomy and loop esophagojejunostomy with or without enteroenterostomy may not be the optimal reconstructive procedures after total gastrectomy because of esophagitis and dumping. More effective esophagointestinal anastomoses have been described [1,3,4,8,9,12]. We have had good success using a Roux-en-Y esophagojejunostomy with and without a jejunal pouch after total gastrectomy for the Zollinger-Ellison syndrome and agree that a jejunal pouch associated with Roux-en-Y esophagojejunostomy as described by Hunt and Lawrence is an excellent reconstructive procedure [1,13]. Several reports using this type of procedure have emphasized the absence of alkaline reflux esophagitis and the ability of their patients to maintain ideal weight [1,2,8].