So JBY, et al. - The clinical symptoms between Billroth II (B-II) and Roux-en-Y (R-Y) reconstruction after distal subtotal gastrectomy (DG) for gastric cancer were compared. Findings revealed that BII was associated with a higher incidence of heartburn symptom and higher median endoscopic grade for gastritis. However, in terms of overall GI symptom score and nutritional status at 1 year after distal gastrectomy, BII and RY were similar.

Methods

• In a prospective multicenter randomized controlled trial, researchers randomly allocated 162 patients who underwent DG to B-II (n = 81) and R-Y (n = 81) groups from October 2008 to October 2014.
• Gastrointestinal (GI) Symptoms Score 1 year after surgery was assessed as the primary endpoint.
• Comparison of nutritional status, extent of gastritis on endoscopy, and quality of life after surgery between the 2 procedures at 1 year was also performed.

Results

• For B-II, operative time was significantly shorter than for R-Y [mean difference 21.5 minutes, 95% confidence interval (95% CI) 3.8–39.3, P = 0.019].
• A peri-operative morbidity of 28.4% and 33.8% was observed for B-II and R-Y group, respectively (P=0.500); the 30-day mortality value was 2.5% and 1.2%, respectively (P=0.500).
• R-Y and B-II reconstruction did not differ in terms of GI symptoms score (mean difference -0.45, 95% CI -1.21 to 0.31, P=0.232).
• In this study, R-Y resulted in a lower median endoscopic grade for gastritis vs B-II (mean difference -1.32, 95% CI -1.67 to -0.98, P < 0.001).
• In addition, no difference in nutritional status (R-Y vs B-II mean difference -0.31, 95% CI -3.27 to 2.65, P=0.837) and quality of life at 1 year between the 2 groups was evident.