Detection of bile reflux gastritis in stomach cancer patients after subtotal gastrectomy using hepatobiliary scintigraphy

Objectives Bile reflux (BR) can be diagnosed using hepatobiliary scintigraphy (HBS). Higher amount of BR may be related to the development of bile reflux gastritis (BRG). We investigated the relation of quantitative bile reflux index (BRI) on HBS with endoscopic BRG.

Methods 55 stomach cancer pts (M:F = 40:15 ; Age 60±10 yr) who had undergone subtotal gastrectomy (Billoth I: 16, Billoth II: 28, Roux-en-Y: 11) were prospectively enrolled. HBS images were obtained at 5 min, 30 min, 60 min, 90 min, and 120 min (post-fatty meal) after Tc-99m mebrofenin injection (555 MBq). Time interval between HBS and endoscopy was 55±51 d (range 0-187 d). Presence of BR was defined as radioactivity in the remnant stomach area. BRI was calculated using left anterior oblique images as % of reflux radioactivity over 30 min hepatobiliary activity. Endoscopic BRG was defined as bile-stained stomach wall with hyperemic mucosal change.

Results Among 55 pts, 30 (55%) showed BR on HBS with mean BRI of 9.3±7.9%, whereas only 13 (24%) had endoscopic BRG. Of 30 pts with BR on HBS, 11 (37%) showed endoscopic BRG. On the other hand, of 25 pts without BR on HBS, only 2 (8%) had endoscopic BRG (p=0.023). The sensitivity and specificity of BRI for BRG diagnosis were 85% and 79%, respectively, with a cutoff value of 4%. Pts with Billoth-II subtotal gastrectomy (STG) had significantly higher prevalence of BR on HBS (78.6%) than those with Billoth-I STG (43.8%) (p=0.019), and those with Roux-en-Y (9.1%) (p<0.01).

Conclusions Higher amount of BR on HBS was related to the development of endoscopic BRG. HBS may be useful for management of post-gastrectomy complications.