J-pouch versus Roux-en-Y reconstruction after gastrectomy: functional assessment and quality of life (randomized trial)
Abstract
Purpose: The aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy. Methods: This study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604).
With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with Tc-99m-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection.
Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated.
Results: In all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5 +/- 10.0 minutes (mean +/- standard deviation) in the Roux-en-Y group and 89.4 +/- 37.8 minutes in the "J-pouch" group; the difference was statistically significant (P < 0.001).
Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106 +/- 18.8 points (mean +/- standard deviation) in the Roux-en-Y group compared to 122 +/- 22.5 points in the J-pouch group; the difference was statistically significant (P = 0.0016).
There were no important adverse events. Conclusion: After total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction.
Whether these two observations have a direct causative link remains unanswered.