Postoperative Gastrointestinal Tract Research Articles

Early Postoperative Gastrointestinal Tract Evaluation: Expected Findings and Complications.

Early Postoperative Gastrointestinal Tract Evaluation: Expected Findings and Complications.

Regular use of low-dose of opioids after gastrointestinal surgery may lead to postoperative gastrointestinal tract dysfunction in children: a Chinese national regional health center experience sharing

BackgroundThe need for pain management is increasing in pediatrics, but the side effects of overuse or abuse of analgesics can be harmful to children’s health and even life-threatening in severe cases.MethodsPatients who underwent resection of Meckel’s diverticulum at the Children’s Hospital of Chongqing Medical University from July 1, 2019, to July 1, 2022, were included in this study. Opioids were administered through patient-controlled analgesia (PCA). Based on the preoperative choices made by the legal guardians, patients were stratified into two groups: PCA Group (PCAG) and Non-PCA Group (NPCAG). Data pertaining to the clinical characteristics and prognoses of these patients were subsequently collected and analyzed to assess the impact of opioid administration.ResultsIn the study, a total of 126 patients were enrolled, with 72 allocated to the Patient-Controlled Analgesia Group (PCAG) and 54 to the Non-Patient-Controlled Analgesia Group (NPCAG). When compared to the NPCAG, the PCAG exhibited a longer duration of postoperative fasting (median 72 vs. 62 h, p = 0.044) and increased utilization of laxatives (12[16.7%] vs. 2[3.7%], p = 0.022). However, the PCAG also experienced higher incidences of intestinal stasis and abnormal intestinal dilation (13[18.1%] vs. 3[5.6%], p = 0.037). No statistically significant differences were observed in pain assessments at the conclusion of the surgical procedure (0 vs. 1[1.9%], p = 0.429) or within the first 24 h postoperatively (16[22.2%] vs. 18[33.3%], p = 0.164). Additionally, NPCAG patients did not necessitate increased administration of rescue analgesics (2[2.8%] vs. 4[7.4%], p = 0.432).ConclusionsThe administration of opioids did not demonstrably ameliorate postoperative pain but was associated with a heightened incidence of postoperative gastrointestinal tract dysfunction. The retrospective nature of the current research should be considered and should be clarified further.

Postoperative ileus in abdominal surgery: in search for a solution to a current problem

In abdominal surgery, after operations on the abdominal cavity, it is possible to develop disturbances in the normal coordinated propulsive motility of the gastrointestinal tract. This episode of gastrointestinal hypomotility or the state of dynamic ileus is referred to as postoperative ileus (POI) or postoperative gastrointestinal tract paresis. The incidence of POI in the clinic of abdominal surgery ranges from 10 to 30%. Chewing gum has been used in surgery to relieve postoperative intestinal obstruction since the early 21st century. The present review considers the main randomized clinical trials, reviews and meta-analyses on the study of the effect of chewing gum in abdominal surgery for the prevention of postoperative ileus. The data presented in the review indicate the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of POI in abdominal surgery and surgical interventions in related areas.

Current problem - postoperative ileus

In abdominal surgery, after operations on the abdominal cavity, it is possible to develop disturbances in the normal coordinated propulsive motility of the gastrointestinal tract. This episode of gastrointestinal hypomotility or the state of dynamic ileus is referred to as postoperative ileus (POI) or postoperative gastrointestinal tract paresis. The incidence of POI in the clinic of abdominal surgery ranges from 10 to 30%. Chewing gum has been used in surgery to relieve postoperative intestinal obstruction since the early 21st century. The present review considers the main randomized clinical trials, reviews and meta-analyses on the study of the effect of chewing gum in abdominal surgery for the prevention of postoperative ileus. The data presented in the review indicate the effectiveness and safety of the use of chewing gum in the postoperative period for the prevention of POI in abdominal surgery and surgical interventions in related areas.

Effects of Modified Baizhu Shaoyao San on Postoperative Diarrhea in Colorectal Cancer Patients: A Single-Blind, Randomized Controlled Trial

Introduction: Postoperative gastrointestinal tract dysfunction is considered a common complication affecting patients undergoing intestinal surgery. This research aims to provide evidence to assess the efficacy and safety of Baizhu Shaoyao San (BSS) or modified BSS in treating postoperative diarrhea of colorectal cancer patients. Methods: Eighty patients with colorectal cancer were randomized within 2 weeks after surgery to receive either modified BSS or Loperamide combined with the respective dummy. The curative effect was evaluated with the traditional Chinese medicine (TCM) syndrome score. Determination of motilin and gastrin in plasma was conducted utilizing ELISA. Results: Compared with Loperamide therapy, the efficacy of modified BSS was statistically significant, the TCM syndrome score decreased, and the total effective rate increased. Levels of motilin and gastrin in plasma decreased. Conclusion: The curative effect and safety of modified BSS were statistically significant.

Standardized implementation of minimally invasive surgery for Siewert Ⅱ esophagogastric junction adenocarcinoma

The incidence of Siewert type II adenocarcinoma of the esophagogastric junction (AEG) is increasing year by year. Due to its special anatomical location and biological behavior, the treatment of AEG is still controversial in terms of lymph node dissection, the esophageal resection margin, range of gastrectomy, and the choice of reconstruction modality for postoperative gastrointestinal tract. The advent of the minimally invasive era has brought the treatment of Siewert type II AEG to a stage of gradual improvement and standardization. Experts of China are also actively exploring the value of minimally invasive surgery in the treatment of AEG through multicenter trials (CLASS-10, etc.). It is believed that based on the active development of many clinical studies, basic experimental studies and large prospective clinical studies, the strengthening of communication and cooperation among various disciplines and the innovative application of new technologies can bring greater survival benefits to patients.

Metabolic activity of gut microbiota in children during their first year of life which had undergone partial bowel resection

Background. Studying the metabolic activity of gut microbiota has diagnostic value as it allows determination of the extent of microbiota perturbation, which is an important indicator of the post-operative gastrointestinal tract function.Objective. The study aimed at investigating the metabolic activity of gut microbiota in children during their first year of life which had undergone partial bowel resection.Methods. The spectrum of fecal short chain fatty acids (SCFA) was assessed using gas-liquid chromatography (GLC). Also, a comparative analysis of clinical and anamnestic data in children of the first year of life which had undergone partial bowel resection versus apparently healthy children was carried out.Results. Dynamic follow-up of children which had undergone bowel surgery revealed a reduction in acetic acid (С2) fecal level and increased propionic acid (С3) and oleic acid (С4) levels by the end of the first year of life. An age-adjusted comparative estimate has shown that the markers of anaerobic microflora, specifically, the level of propionic acid, are also high at the age of 7–12 months. A comparative analysis of metabolic activity of gut microbiota in children which had undergone bowel resection revealed lower fecal levels of oleic acid and higher total fatty acid content as compared to healthy children.Conclusion. Children which had undergone bowel resection, by the end of first year of life, have higher anaerobic and lower aerobic activity of gut microflora. A comparative analysis of metabolic activity of gut microflora in children which had undergone surgical treatment versus children of health groups I and II demonstrated the absence of significant differences between obligate (С2) and anaerobic (С3, anaerobic index [AI]) bacteria. However, lower fecal С4 values have been found in post-operative children during their second half-year of life, which may attest to persistent inflammation of the gut. Total fecal acid content throughout the entire follow-up period was higher in children which had undergone bowel resection, which reflects the activation of gut microbiota characterized by its species diversity.

Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols.

Postoperative ileus (POI) and postoperative gastrointestinal tract dysfunction (POGD) are well-known complications affecting patients undergoing intestinal surgery. GI symptoms include nausea, vomiting, pain, abdominal distention, bloating, and constipation. These iatrogenic disorders are associated with extended hospitalizations, increased morbidity, and health care costs into the billions and current therapeutic strategies are limited. This is a narrative review focused on recent concepts in the pathogenesis of POI and POGD, pipeline drugs or approaches to treatment. Mechanisms, cellular targets and pathways implicated in the pathogenesis include gut surgical manipulation and surgical trauma, neuroinflammation, reactive enteric glia, macrophages, mast cells, monocytes, neutrophils and ICC’s. The precise interactions between immune, inflammatory, neural and glial cells are not well understood. Reactive enteric glial cells are an emerging therapeutic target that is under intense investigation for enteric neuropathies, GI dysmotility and POI. Our review emphasizes current therapeutic strategies, starting with the implementation of colorectal enhanced recovery after surgery protocols to protect against POI and POGD. However, despite colorectal enhanced recovery after surgery, it remains a significant medical problem and burden on the healthcare system. Over 100 pipeline drugs or treatments are listed in Clin.Trials.gov. These include 5HT4R agonists (Prucalopride and TAK 954), vagus nerve stimulation of the ENS—macrophage nAChR cholinergic pathway, acupuncture, herbal medications, peripheral acting opioid antagonists (Alvimopen, Methlnaltexone, Naldemedine), anti-bloating/flatulence drugs (Simethiocone), a ghreline prokinetic agonist (Ulimovelin), drinking coffee, and nicotine chewing gum. A better understanding of the pathogenic mechanisms for short and long-term outcomes is necessary before we can develop better prophylactic and treatment strategies.

External use of Mirabilite combined with Lactulose improves postoperative gastrointestinal mobility among older patients undergoing abdominal surgery.

To evaluate the feasibility and efficacy of Mirabilite combined with Lactulose in older patients after abdominal surgery. It is a retrospective observational cohort study with a pre and post intervention group. Medical records were retrospectively reviewed of postoperative Intensive Care patients with postoperative gastrointestinal tract dysfunction (aged >60years) in the Surgical Intensive Care Unit from January 2017-December 2018. One hundred and sixty-seven post-surgical Intensive Care patients with postoperative gastrointestinal tract dysfunction were analysed; 74 patients received Mirabilite+Lactulose treatment and 93 patients received Lactulose treatment. The recovery rate of bowel sounds was better in the Mirabilite+Lactulose group (62.16%) compared with the Lactulose group (37.63%) after 3-day treatment (p=0.002) and the relative risk (RR) was 1.65 (95% CI, 1.20, 2.27). Moreover 70.27% patients in the Mirabilite+Lactulose group finally had flatus or defecation compared with 46.24% patients in Lactulose group (p=0.003) and the RR was 1.52 (1.17, 1.98). The abdominal girth and Inter Abdominal Pressure in Mirabilite+Lactulose group showed significantly greater decrease over a 3-day period compared with Lactulose group (4.86 vs. 3.46cm, p=0.027; 4.80 vs. 3.11mmHg, p=0.002 respectively). The pain score had greater decrease from the baseline in Mirabilite+Lactulose group than in Lactulose group (2.40 vs. 1.11; p<0.01). Patients in the Mirabilite+Lactulose group had shorter hospital stay than the Lactulose group 12.5 (SD 3.51) versus 13.9 (SD 5.14), p=0.05. This study demonstrated that external use of Mirabilite combined with Lactulose can be considered as an easy intervention to improve postoperative gastrointestinal mobility in older intensive care patients who suffer from postoperative gastrointestinal tract dysfunction after surgery. Our results provide a great option to alleviate the sufferings of postoperative patients. The externally use Mirabilite is a painless and safe interventions that is easy to implement by ICU nurses.

Nalbuphine on postoperative gastrointestinal tract dysfunction after laparoscopic surgery for gynaecological malignancies: A randomized controlled trial.

The aim of this study was to compare the effects of nalbuphine and sufentanil on the gastrointestinal (GI) tract after laparoscopic surgery for gynaecological malignancies. A total of 100 patients with American Society of Anesthesiologists (ASA) physical status I-II undergoing laparoscopic radical hysterectomy under general anaesthesia were enrolled. The patients were randomized to receive sufentanil (Group S) or nalbuphine (Group N) intraoperatively and postoperatively. The time to first passage of flatus, the time to first defaecation, the time to toleration of diet, the serum gastrin level, and the duration of hospital stay of the groups were compared. The Visual Analogue Scale (VAS) score for postoperative pain, the number of dispensed patient-controlled analgaesics (PCAs), and the prevalence of postoperative nausea, vomiting, and dizziness of the groups were also compared. The time to first passage of flatus (P=.551), time to first defaecation (P=.310), time to toleration of diet (P=.182), serum gastrin level (P=.397), prevalence of postoperative nausea (P=.920) and vomiting (P=.334), number of dispensed PCAs (P=.167), and the duration of hospital stay (P=.482) of the two groups were not significantly different. The VAS scores at 6hours (P=.008), 12hours (P=.002), and 24hours (P=.013) postoperatively were lower in Group N than in Group S. In conclusion, nalbuphine was not associated with improved postoperative GI dysfunction after laparoscopic surgery for gynaecological malignancies, but it was associated with reduced postoperative pain.

Impact of Minimal Invasive Robotic Surgery on Recovery From Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction.

Postoperative gastrointestinal tract (GIT) dysfunction (POGD) and postoperative ileus (POI) are common symptoms resulting from small or large bowel surgery associated with extended hospitalizations, increase risk of infections and billions of dollars in health care costs. Open surgery is associated with higher gut surgical trauma / manipulation and worse outcomes compared to minimal invasive surgery. Robotic Surgery may offer added benefit to Colon Enhanced Recovery After Surgery (CERAS) protocols but do not solve the problem. Ultimately, a better understanding of the pathogenic mechanisms of POI and POGD can lead to prophylaxis and enhanced recovery after surgery. The impact of High Pressure Pneumoperitoneum and gut surgical manipulation on GIT dysfunction deserve further investigation.

Application of tubular stomach reconstruction via the posterior mediastinal approach in the Iovr-Lewis radical resection of esophageal cancer

Objective To explore the surgical technique and analyze the clinical efficacy of tubular stomach reconstruction via the posterior mediastinal approach after Iovr-Lewis radical resection of esophageal cancer. Methods The clinical data of 63 patients with middle-lower esophageal cancer who were admitted to the First People's Hospital of Chengdu between April 2013 and April 2015 were retrospectively analyzed. All the patients underwent Iovr-Lewis radical resection of esophageal cancer and tubular stomach reconstruction via the posterior mediastinal approach. Video-assisted minithoracotomy (VAMT) was used for anastomosis of esophagus-gastric tube at the top of thorax after laparoscopic abdominal surgery, and then tubular stomach reconstruction via the posterior mediastinal approach was performed by placing gastric tube in the esophageal bed and closing the posterior mediastinal pleura. Patients received regular perioperative treatment. Intraoperative record included operation time, volume of blood loss, volume of blood transfusion and lymph nodes dissection. Postoperative anastomotic leakage was detected by observing thoracic drainage, symptoms of fever, chest pain and elevated hemogram, recovery of intestinal function and closed thoracic drainage-tube removal time. Follow-up was performed by telephone interview and outpatient examination up to April 2015, including with or without normal food intake, gastroesophageal reflux and tumor progression. Results All the patients underwent successful Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach without perioperative death and intraoperative blood transfusion. The average operation time, average volume of intraoperative blood loss and average number of lymph nodes dissected were 230 minutes, 300 mL and 16, respectively. Patients received gastric tube removal at postoperative day 2 with a good condition of tubular stomach by CT examination. The average time of postoperative gastrointestinal tract recovery was 3 days. Patients took fluid diet at postoperative day 3-4, soft diet at postoperative day 7 and regular diet at postoperative day 10-12. Two patients complicated with slight pulmonary infection were cured by conventional treatment. The closed thoracic drainage-tube removal time was 4 days. All the patients were followed up for a median time of 8 months (range, 1-24 months) with regular diet intake and without perioperative death, tumor recurrence, severe gastroesophageal reflux and other complications. Conclusions Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach is safe and feasible, with the advantages of preventing the esophageal anastomotic fistula, reducing postoperative pulmonary infection and promoting early diet intake and enhancing postoperative recovery of patients. Key words: Esophageal neoplasms; Anastomtic fistula; Enhanced recovery

Using Submucosal Tunneling Endoscopic Resection to Treat Submucosal Tumor

Introduction: This video shows the submucosal tunneling endoscopic resection (STER). Today, endoscopic submucosal dissection (ESD) is increasingly used for superficial esophageal cancers and esophageal submucosal tumors (SMTs),1,2 but the surgical area in the esophagus is limited and the esophageal adventitia is very thin. As improved ESD technology, STER can reduce risk of postoperative gastrointestinal (GI) tract leakage and secondary infection.3 Method: This was a 56-year-old patient who found it difficult to swallow since November 23rd 2013. Then, she went to hospital and had a computer tomography (CT) scan and endoscopic ultrasonography; both of them showed there was an SMT in the middle segment of the esophagus. The patient had no other symptoms besides dysphagia, and the blood routine examination is regular. On December 4th 2013, we decided to use STER to treat this lesion. After a short anesthesia induction, we found there had been a lesion of about 1.5×1.5 cm with smooth surface in the middle segment of the esophagus, 21 cm far from the incisor. Then, we made the submocosal injection of diluted indigo carmine to locate the SMT. Next, a fluid cushion was obtained using an injection needle 5 cm proximal to the SMT, and a 2-cm longitudinal mucosal incision was made using the electric knife at the esophageal mucosa as the entry point. With the electric knife, a submucosal longitudinal tunnel was created between the submucosal and muscular layers. We made the tunnel end 1–2 cm distal to the tumor to ensure a satisfactory endoscopic view and enough space to work. In the tunnel, we resected the SMT under direct endoscopic visualization safely and completely. After removing the SMT, hemostatic clips were used to close the tunnel and the STER ended. Results: The pathology shows that the lesion was a spindle cell tumor and has no lymph node metastasis. The patient woke up in half an hour after STER and was discharged 3 days after the endoscopic resection. Also, she was seen 1, 2, and 4 weeks after this resection with no symptoms to report. Conclusion: To treat the SMT in the esophagus, the surgical area is limited and the esophageal adventitia is very thin for ESD. STER provides enough work space for the surgeon and reduces the infection and bleeding during the resection of the lesion. There is no conflict of interest of any kind in relation to this article between Shilun Cai, Yunshi Zhong, and Liqing Yao. Runtime of video: 8 mins 29 secs

Initial experiences in robot‐assisted middle pancreatectomy

ObjectivesInitial results in robot‐assisted middle pancreatectomy (MP) have been encouraging. However, data comparing outcomes of robot‐assisted MP with those of open MP are limited. The aim of this study was to compare outcomes in patients undergoing open and robot‐assisted MP, respectively. MethodsOutcomes in an initial experience with seven consecutive patients undergoing robot‐assisted MP were compared with those in 36 patients undergoing open MP. ResultsThe robot‐assisted MP group included five women and two men with a median age of 55 years (range: 30–62 years). Median tumour size, operative time and blood loss were 3.0 cm (range: 0.5–5.0 cm), 210 min (range: 150–330 min) and 200 ml (range: 50–400 ml), respectively. Pancreaticogastrostomy was performed in all patients. No transfusion was given intraoperatively. Pathological examination revealed five serous cystic neoplasms, one mixed‐type intraductal papillary mucinous neoplasm and one lipoma. Five patients experienced postoperative pancreatic fistula and one experienced post‐pancreatectomy haemorrhage. No operative mortality was noted. Compared with the open MP group, the robot‐assisted MP group demonstrated a shorter median length of postoperative gastrointestinal tract recovery [2 days (range: 2–3 days) versus 4 days (range: 2–11 days); P = 0.001]. conclusionsRobot‐assisted MP can be performed safely with satisfactory efficacy; patients experienced faster gastrointestinal tract recovery compared with patients undergoing open surgery.

Usefulness of Double-Balloon Endoscopy in the Postoperative Gastrointestinal Tract

Background. The small intestine has been considered to be a highly difficult organ to visualize in imaging examinations due to its anatomical location compared with the stomach and the colon. In recent years, many imaging modalities have become available, such as CT enterography, MR enterography, capsule endoscopy (CE), and double-balloon endoscopy (DBE). Patients and Methods. DBE was performed in the postoperative intestines of 91 patients (128 DBE examinations) at Iwate Medical University between 2004 and 2010. There were 61 male and 30 female patients, and their mean age was 69.7 years (range: 30–80 years). Results. A total of 124 DBE examinations were performed with endoscope insertion into the reconstructed intestines. The endoscope reached the blind end in 115 of 124 examinations, (92.7%). There were 17 patients with obscure gastrointestinal bleeding in whom 30 DBE examinations were performed. The bleeding site was identified in 12 patients (70.6%). Nine patients underwent endoscopic treatment. Hemostasis was achieved in all patients. Conclusion. DBE is very useful modality for the assessment and application of endotherapy to areas of the small bowel which have been altered by surgery.

Postoperative gastrointestinal tract dysfunction: An overview of causes and management strategies

Postoperative gastrointestinal (GI) tract dysfunction is common and has a complex, multifactorial pathogenesis. Perioperative administration of targeted amounts of fluid to optimize ventricular filling and end-organ perfusion has consistently been shown to improve mortality and other outcomes, particularly GI tract perfusion and function. The choice of fluid loading affects postoperative recovery, with colloid showing superiority over crystalloid, and lactated Ringer's solution proving better than normal saline. Other methods of reducing postoperative GI tract dysfunction with some proven degree of success include simple, low-cost interventions such as early initiation of oral feeding, early use of laxatives, and gum chewing. There is no evidence that prophylactic nasogastric decompression accelerates return of bowel function.

Development and evaluation of postoperative gastrointestinal tract dysfunction score in extra‐abdominal surgery: a prospective study

Development and evaluation of postoperative gastrointestinal tract dysfunction score in extra‐abdominal surgery: a prospective study

Laparoscopic Colorectal Resection for Bowel Endometriosis

To evaluate the short- and long-term outcomes of laparoscopic colorectal resection for endometriosis. This study included 357 consecutive patients who underwent colorectal resection. We evaluated intraoperative and postoperative complications, symptom outcomes, and long-term follow-up. Three hundred forty-three patients (96.1%) underwent laparoscopic colorectal resection, and radical endometriosis ablation was in 334 patients (93.6%). Fourteen (3.9%) required laparoconversion. Median operating time was 300 (range, 85-720) minutes, with a median estimated blood loss of 250 (range, 50-550) mL. Radical endometriosis ablation was achieved in 334 patients (93.6%). Median ileus was 4 (range, 1-8) days, with a median postoperative hospitalization of 8 (range, 3-36) days. Early and late complications were observed in 44 patients (12.3%) and, in 35 of these (79.5%), surgical management was necessary. Median follow-up after colorectal resection was 19.6 (range, 6-48) months. The median preoperative and postoperative dyspareunia scores were 8 (range, 4-10) and 3 (range, 0-10), respectively (P < .04), and the median preoperative and postoperative gastrointestinal tract symptom scores were 7 (range, 2-10) and 2 (range, 0-10), respectively (P < .05). During follow-up, 24 of 286 recurrences (8.4%) were registered. Patients who previously underwent surgery for endometriosis showed a higher risk of recurrence compared with patients undergoing primary surgery (13.2% vs 3.4%; P < .048). Laparoscopic colorectal resection for severe endometriosis is feasible and markedly improved endometriosis-related symptoms. Despite the risk of major postoperative complications, the procedure shows good results in terms of recurrence rate and could be adopted as the primary approach for patients with symptomatic colorectal infiltrating endometriosis.

Commentary on Two Classic GI Studies

Commentary on Two Classic GI StudiesRobert J. Stanley1Audio Available | Share

Usefulness of Double-Balloon Endoscopy for Diagnosis and Treatment of the Post-Operative Gastrointestinal Tract

Backgrounds and Aims: Endoscopic examination of the afferent limb, or choledocho-jejunostomy, in patients with various surgical reconstructions of the gastrointestinal tract, such as Roux-en-Y anastomosis or Billroth II gastrojejunostomy, is often extremely difficult due to anatomical characteristics and intestinal adhesion. Although the advent of video capsule endoscopy facilitated the observation of the entire small bowel, one of the limitations of this new technology includes the difficulty of accessing the surgically reconstructed gastrointestinal tract. Double-balloon endoscopy (DBE) (Fujinon, EN-450P5/20, EN-450T5/20, Fuji Photo Optical Co., Ltd., Saitama, Japan) facilitates the selective inspection of discrete intestinal regions, and allows for timely endoscopic treatment of disorders heretofore requiring surgical intervention. In this study, we evaluated the efficacy of double-balloon endoscopy in patients with surgically reconstructed gastrointestinal tracts. Patients: A total of 130 patients underwent 200 DBE examinations between Jun. 2003 and Nov. 2005 at Nippon Medical School Hospital, Tokyo, Japan. Among them, 12 consecutive patients with surgically reconstructed gastrointestinal tracts were enrolled. The median age of these 12 patients was 65.3 (30-81); 6 men and 6 women. The surgical procedures of these patients included Billroth II gastrojejunostomy in 5 patients, Roux-en-Y anastomosis in 3 patients, pancreatoduodenectomy in 3 patients, and blind loop with side to side anastomosis in 1 patient. Results: DBE could reach the cecum of the afferent loop in 10 of 12 patients (83.3%), with endoscopic access and direct observation successfully carried out in all these 10 patients. Cholangiocellular carcinomas were found in 2 patients, choledocholithiasis in 2 patients, and 4 patients underwent the procedure for endoscopic retrograde cholangiography (ERC). Anastomotic stricture after Roux-en-Y anastomosis was found in 1 patient who had been suffering from symptoms of ileus. A detachable stent was placed at the stricture, and clinical symptoms improved. No complications were encountered during and after any of these procedures. Conclusions: DBE is a very useful and safe tool for the diagnosis and treatment of lesions in the surgically reconstructed gastrointestinal tract. It may also preclude unnecessary surgical intervention in certain cases.