Success Rate and Factors Associated With Surveillance Endoscopy After Proximal Gastrectomy With Double-Tract Reconstruction: A Retrospective Multicenter Cohort Study.

Abstract

Purpose: This study aimed to analyze the rate of adequate observation of the remnant stomach after proximal gastrectomy (PG) with double-tract reconstruction (DTR).

Materials and methods: Data from patients who underwent PG with DTR for gastric cancer at 6 institutions in South Korea were included. The clinicopathological and serial endoscopic data were retrospectively analyzed. Successful surveillance endoscopy was defined as photographic documentation of the pyloric antrum. Factors associated with successful endoscopy were analyzed using a mixed-effects logistic regression model.

Results: In total, 634 surveillance endoscopies were performed in 160 patients after they underwent PG with DTR. The median time from surgery to endoscopy was 17.5 months (range, 0-137 months). The overall success rate of endoscopy was 75.6%. The mean total procedure time for successful endoscopies was 439.4±336.0 seconds, compared with 373.7±326.0 seconds for failed examinations (P=0.033). Although 31.9% of the patients experienced failure during their first endoscopy, all but 3 patients achieved at least one successful endoscopy by the fourth session. Factors associated with successful endoscopy included longer procedure time (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.01-1.72), endoscopy performed by an endoscopist without prior PG experience (OR, 0.19; 95% CI, 0.11-0.36), and a longer duration after surgery (OR, 1.33; 95% CI, 1.02-1.72).

Conclusions: Understanding the anatomical changes after PG with DTR is essential for successful surveillance endoscopy. In addition, the failure rates across all serial endoscopies are very low. Therefore, clinicians should ensure sufficient procedure time during endoscopy, regardless of the outcomes of previous examinations.