Billroth I and II reconstructions are commonly performed after distal
gastrectomy. Both may cause duodenogastric and duodenogastroesophageal reflux, conditions reported to have carcinogenetic potential. The aim of this study was to investigate which reconstructive procedure would most effectively prevent
bile reflux into the gastric remnant and esophagus after distal
gastrectomy. A group of 92 patients who underwent curative distal
gastrectomy for
gastric cancer were subjected and classified into three groups retrospectively by the reconstructive procedure undertaken: group A, Roux-en-Y (Roux-Y) reconstruction (n = 29); group B,
Billroth I reconstruction (n = 41); group C,
Billroth II reconstruction (n = 22). The
bile reflux periods (percent time) for the gastric remnant and esophagus were measured with the Bilitec 2000 under standardized conditions. The percent time for the gastric remnant was significantly less in group A than in group B or C. In 61% of all patients,
bile reflux into the esophagus was found to be more than 5.0% of the time; it was less in group A than in group B or C (p = 0.057). A questionnaire revealed a good correlation between the incidence of reflux symptoms and the percent time for the gastric remnant and esophagus. Roux-Y reconstruction is superior to either
Billroth I or II reconstruction for preventing
bile reflux into the gastric remnant and esophagus after distal
gastrectomy.