[Demonstration of postgastrectomy bile reflux by hepatobiliary sequential scintigraphy]. / Nachweis von Gallereflux nach Gastrektomie mit der hepatobiliären Sequenzszintigraphie (HBSS).

ABSTRACT

After gastrectomy and jejunal interposition by the Longmire technique, symptoms due to alkaline reflux oesophagitis may occur, which are caused by duodeno-jejunal and jejuno-oesophageal bile reflux. Twenty-seven patients who had gastrectomies performed for malignant tumours one to three years previously were examined by hepatobiliary sequential scintigraphy in order to see whether this is able to demonstrate bile reflux. In addition to endoscopies, biopsies and radiological examinations, 45 sequential scintigrams were carried out. Agreement of results during routine use was investigated for five observers. There were considerable variations in results amongst different observers. Nevertheless, in four out of the five observers, there was a significant correlation with the clinical findings (p less than 0.05). Only by using functional scintigraphy with digital data recording is it possible to demonstrate or exclude bile reflux with any degree of certainty. Eight out of twelve patients with marked symptoms, and four out of 28 without symptoms showed reflux into the interposed segment (correlation 0.7, p greater than 0.05). Patients with symptoms showed a high incidence of oesophagitis by the above-mentioned methods (correlation (0.52, p greater than 0.05). Correlation between the results of barium meals and clinical findings was considerably less (0.25) and was not significant. Sequential scintigraphy is therefore better for clarifying reflux symptoms than radiological examination or endoscopy and biopsy.