Intestinal transit of food after total gastrectomy and Roux-Y esophagojejunostomy

Abstract

We examined small bowel transit of solid food in 10 patients 3 to 30 months after total gastrectomy and Roux-Y esophagojejunostomy and compared the transit pattern with that in five control subjects. All persons ate a test meal consisting of 213 g of beef stew mixed with 30 g of chicken liver which was labeled with 1 mCi of technetium 99m sulfur colloid, and they stood in front of a gamma scintillation camera and were studied for 6 to 10 hours. Solid food passed rapidly from the esophagus through the Roux-Y limb and became uniformly distributed throughout a long segment of the small intestine. Mouth-to-colon transit time was 223 ± 18 minutes in the control subjects and 298 ± 37 minutes in the patients with gastrectomy. Small bowel transit of the head of the meal was 187 ± 19 minutes in the control subjects and 293 ± 37 minutes in the patients (p < 0.02). Transit time of the tail of the meal was 175 ± 26 minutes in the control subjects and 396 ± 28 minutes in the patients (p < 0.001). After total gastrectomy and Roux-Y esophagojejunostomy, the proximal jejunum does not act as a reservoir; transit of food through the small intestine is slower than in control subjects, and because the proximal jejunum empties rapidly during eating, a meal of normal size can be consumed. These findings do not support the idea that an artificial gastric reservoir is important after total gastrectomy.