Food passage following proximal gastrectomy with double-tract reconstruction and its effect on nutritional status in early gastric cancer

This study aimed to investigate the food passage patterns following laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) and its effect on nutritional outcomes up to 1 year in patients with upper-third gastric cancer. Ten patients with early gastric cancer scheduled for LPG-DTR were enrolled in this prospective cohort study, with data collected over 12 months. Liquid and solid food transits were evaluated with fluoroscopic upper gastrointestinal study and radionuclide scintigraphy, respectively. The findings revealed that the serum vitamin B12 levels initially decreased but recovered to the baseline level within 12 months. Patients lost 14.5% ± 3.6% of their initial bodyweight. The main passage routes between liquid and solid foods were different, which was mainly via the interposed jejunum in liquid contents, whereas via both tracts following solid food intake. The median half-life of solid food emptying from the remnant distal stomach was 105.1 minutes, and duodenal passage of solid food was noted in 9 of 10 patients. In conclusion, LPG-DTR demonstrated varying food passage patterns depending on the food contents. The emptying of solid food from the remnant stomach through the pyloric ring was considerably delayed, which could be related to the ineffective prevention of weight loss.