Incidence of Reflux Esophagitis After Pancreaticoduodenectomy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01311908
Recruitment Status : Unknown
Verified March 2011 by National Taiwan University Hospital.
Recruitment status was:  Recruiting
First Posted : March 10, 2011
Last Update Posted : March 23, 2011
Information provided by:
National Taiwan University Hospital

Brief Summary:
Reflux esophagitis is a common complication following distal gastrectomy. According to the investigators preliminary data, an Roux-en--Y gastrointestinal reconstruction in pancreaticoduodenectomy is associated with higher rates of reflux esophagitis. In this study, the investigators will investigate the incidence of reflux esophagitis after above procedure by the 24-h pH monitoring of esophagogastric junction.

Condition or disease Intervention/treatment
Reflux Esophagitis Procedure: Methods of gastrojejunostomy reconstruction

Detailed Description:

Reflux esophagitis is a common complication following distal gastrectomy. Recently, an Roux-en--Y gastrointestinal reconstruction has been used increasingly to prevent reflux esophagitis; however, reflux esophagitis after pancreaticoduodenectomy (also including distal gastrectomy) has never been studied.

In our preliminary retrospective study of 371 patients having PD (158 standard PD and 213 pylorus-preserving PD) at our hospital, after a median follow-up of 20 months (range, 2-110 months), 40 patients (10.8%) developed reflux esophagitis — 15 (9.5%) in the standard PD group, and 25 (11.7%) in the PPPD group. Multivariate logistic regression analysis revealed the only significant factors related to reflux esophagitis is Roux-en-Y gastrointestinal reconstruction independent of preservation of the pylorus.

To our surprise, there is no significant difference in occurrence of GERD between patients after standard PD (15 of 158 patient) and PPPD (25 of 313 patients, P=0.49). We postulate reflux esophagitis following a PPPD in patients without past history of GERD is most likely caused by disruption of reflux-preventing systems at the gastroesophageal junction, thereby allowing reflux of gastric acid into esophagus. If the postulation is true, GERD after PPPD should be acidic in nature. To test this hypothesis we propose a prospective randomized study to compare preoperative and postoperative parameters, including esophageal morphology, bile acid concentration, trypsin activity of esophageal refluxate, COX2 mRNA expression of lower esophageal mucosa, and 24 hour pH monitor of lower esophagus.

Moreover, to test the effect of a Roux-en-Y reconstruction to prevent GERD after PD, studied patients will be randomized into Roux-en-Y and control groups to study inter-group differences in incidence of GERD and marginal ulcer after PD.

Acidic GERD should be treated with proton pump inhibitor. In contrast, alkaline GERD should be treated with pro-kinetic agent such as primperan and mopride. With this study, we can learn more about the nature of post-PD GERD following various gastrointestinal reconstructions and can give patient more personalized therapy.

Study Type : Observational
Estimated Enrollment : 50 participants
Observational Model: Case Control
Time Perspective: Prospective
Official Title: Effect of a Roux-en-Y Reconstruction on Reflux Esophagitis After Pancreaticoduodenectomy
Study Start Date : March 2011
Estimated Primary Completion Date : March 2012
Estimated Study Completion Date : December 2012

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Group/Cohort Intervention/treatment
Surgery, Roux-en-Y , reflux esophagitis
Patients with roux-en-Y reconstruction (study group)
Procedure: Methods of gastrojejunostomy reconstruction
Roux-en-Y reconstruction in pancreaticoduodenectomy
Other Names:
  • Reconstruction of gastrojejunostomy
  • Roux-en-Y anastomosis versus gastrojejunostomy only
surgery, traditional gastrojejunostomy
Traditional gastrojejunostomy reconstruction (control group).

Primary Outcome Measures :
  1. Incidence and severity of reflux esophagitis [ Time Frame: 3 months ]
    Use panendiscopy to assess the reflux esopagitis

Secondary Outcome Measures :
  1. Incidenc of marginal ulcer [ Time Frame: 3 months ]
    Use endoscopy to assess the marginal ulcer

Biospecimen Retention:   Samples With DNA
esophageal mucosal biopsy for Real-Time PCR for COX-2 activity

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
tudy the effect of a Roux-en-Y reconstruction on GERD and marginal ulcer after pancreaticoduodenectomy

Inclusion Criteria:

  • age greater than 18 years and planned PD for a lesion of either the pancreatic head or the periampullary region

Exclusion Criteria:

  • history of abdominal or pelvic radiation
  • hepatic dysfunction (Child-Pugh > 2)
  • renal dysfunction (serum creatinine concentration > 3 mg/L, hemodialysis, or both)
  • cardiac dysfunction (New York Heart Association functional class > III, stroke history)
  • pregnancy
  • history of intestinal anastomosis of the large bowel without a diverting stoma

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01311908

Contact: Yu-Wen Tien, M.D., Ph.D.

National Taiwan University Hospital Recruiting
Taipei, Taiwan, 100
Contact: Yu-Wen Tien         
Principal Investigator: Yu-Wen Tien         
Sponsors and Collaborators
National Taiwan University Hospital
Principal Investigator: Yu-Wen Tien, M.D., Ph.D. Department of surgery, National Taiwan University Hospital

Responsible Party: Tien Yu-Wen, M.D., Ph.D., National Taiwan University Hospital Identifier: NCT01311908     History of Changes
Other Study ID Numbers: 201005058R
First Posted: March 10, 2011    Key Record Dates
Last Update Posted: March 23, 2011
Last Verified: March 2011

Keywords provided by National Taiwan University Hospital:
Roux-en-Y reconstruction
Reflux esophagitis

Additional relevant MeSH terms:
Gastroesophageal Reflux
Esophagitis, Peptic
Esophageal Motility Disorders
Deglutition Disorders
Esophageal Diseases
Gastrointestinal Diseases
Digestive System Diseases
Peptic Ulcer
Duodenal Diseases
Intestinal Diseases
Stomach Diseases