2-1 ; The Effect of Jejunal Interposition on Iron Deficiency in Patients of Radical Subtotal Gastrectomy

Objective: Decreased gastric acid and reflux gastritis after radical subtotal gastrectomy (RSG) and duodenal bypass after gastrojejunostomy may increase the frequency and severity of iron deficiency and anemia. The objective of this study was to investigate changes of serum iron level after RSG with jejunal interposition by comparing various reconstruction methods. Methods: 293 patients were evaluated who received RSG for gastric cancer with gastroduodenostomy (BI, 144cases), gastrojejunostomy (BII, 76), and jejunal interposition (JI, 73) from April 2007 to June 2010. We investigated blood hemoglobin, MCV, MCHC, iron, TIBC, and ferritin before, 6weeks after, 6months after, and 1 year after RSG. Statistical analyses were carried out with SPSS software. Differences were analyzed by paired samples test and ANOVA test. Results: Mean age was 60.1 years, sex ration 1.38:1, BMI>25 117cases, stage Ia 174, Ib 34, IIa 20, IIb 23, IIIa 18, IIIb 9, IIIc 15cases. Percentages of patients with Hb level lower than normal were 35.4, 65.2, 53.4, 39.8 % in BI, 39.5, 62.1, 60.9, 58.1% in BII, and 41.1, 80.8, 63.2, 56.1% in JI. Percentages of patients with serum iron lower than normal were 40.7, 40.5, 19.8, 21.7% in BI, 45.8, 40.0, 44.0, 34.3% in BII, and 40.6, 46.6, 23.0, 16.7% in JI. Conclusion: Percentage of patients with normal Hb level was high in BI 6weeks and 1year after RSG, and percentage of patients with normal iron level in JI 1year after RSG. Iron deficiency was improved in the patients with jejunal interposition.