Retained Gastric Antrum Syndrome

Dumon K, Dempsey DT. (2019). Postgastrectomy Syndromes. Shackelford’s Surgery of the Alimentary Tract, 8th ed.: 719-734.

“Hypergastrinemia after distal gastrectomy can be caused by gastrinoma or retained antrum. In the latter there is residual antral tissue left in continuity with the duodenal stump after gastric resection with Billroth II anastomosis. The G cells in this retained antral tissue are not exposed to luminal acid, resulting in continuous secretion of gastrin and intense stimulation of acid production by parietal cells in the proximal gastric remnant. The exposure of the unbuffered jejunum to this high acid level at the Billroth II GJ results in marginal ulcer (see Fig. 62.12B ).

Clinical suspicion of retained antrum may be confirmed by review of previous operative and pathology reports, barium upper GI study, and/or technetium 99m scan. Reexcision is curative. Gastrinoma is suspected when secretin infusion leads to significant further elevation of gastrin level. CT, endoscopic ultrasound (EUS), and octreotide scan may be helpful, but exploration by an experienced surgeon is the best way to find the tumor(s) if operation is indicated.”

FIGURE 62.12
Pathophysiology of retained antrum syndrome. (A) Normal stomach with antrum. A segment of incompletely resected antrum bathed in the alkaline environment of the adjointed duodenum during distal gastrectomy with (B) Billroth II or (C) Roux-en-Y reconstruction results in intense gastrin secretion by the retained antrum and causes marginal ulceration as depicted in (B) and (C).
(From Bolton JS, Corway WC, Postgastrectomy syndromes. Surg Clin N Am . 2011;91:1105–1122.)

See also:

Bolton JS, Conway WC 2nd. Postgastrectomy syndromes. Surg Clin North Am. 2011

Katsinelos P, et al. Education and imaging. Gastrointestinal: retained gastric antrum. J Gastroenterol Hepatol. 2007 Mar;22(3):448.

Gibril F, et al. Retained gastric antrum syndrome: a forgotten, treatable cause of refractory peptic ulcer disease. Dig Dis Sci. 2001 Mar;46(3):610-7.

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