Partial Gastrectomy Examination

Checklist for endoscopic evaluation

► Inspect the esophagus, particularly the gastroe-sophageal junction.

► Inspect the gastric remnant.

► Inspect the anastomotic ring.

► Billroth I stomach and Roux-en-Y gastrojejunostomy

- Inspect the efferent loop.

- Inspect the afferent loop as far as the stump.

- Inspect the efferent loop as far as the Braun anastomosis, if present.

Pathological findings (Fig. 3.125)

Reflux esophagitis

Redness, erythema, erosion at the anastomotic site

Increased fragility of the mucosa

Nodule formation at the anastomosis

Polypoid mucosa

Ulcerations

Neoplastic, carcinomatous mucosal changes

Anastomotic stenosis

Bezoar in the gastric remnant

Biliary secretion in the gastric remnant

Additional Studies

► Generous biopsy

► Upper gastrointestinal series

Fig. 3.124 Billroth II operation a View of the afferent and efferent loops

Fig. 3.124 Billroth II operation a View of the afferent and efferent loops

b View of the major papilla c The endoscope has been advanced into the afferent loop b View of the major papilla c The endoscope has been advanced into the afferent loop

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