Development and current status of anti-reflux esophagogastrostomy after proximal gastrectomy: a literature review

Background: The selection of an appropriate gastrointestinal (GI) reconstruction procedure after proximal gastrectomy (PG) has long been a challenge. Surgeons have had a long history of exploring anti-reflux gastroesophageal anastomosis. The aim of this article is to systematically summarize the anti-reflux principles of GI reconstructive procedures through a review of the previous literature and to provide a theoretical basis for clinicians to select or innovate procedures.

Methods: The PubMed, Google Scholar, China National Knowledge Infrastructure, Cochrane Databases and Medline were searched using Medical Subject Headings terms and keywords from inception until May 1, 2023. We traced the early research on the anti-reflux mechanisms of the esophagogastric junction and analyzed each piece of literature.

Results: Three principles according to the current mainstream anti-reflux esophagogastrostomy: (1) reduction of the acid secreting glands; (2) reconstruction of the His angle or fundus; (3) reconstruction of the anti-reflux valve resembles the cardiac (including barrier method, rotation method, and compression method). This article provides a literature review of anti-reflux esophagogastrostomy after PG.

Conclusions: Anti-reflux esophagogastrostomy, represented by seromuscular flap valvuloplasty, which restored the natural physiological structure, had better feasibility and safety theoretically. However, this still needs to be supported by evidence from large multi-center prospective randomized controlled studies.