Current status and trends of anti-reflux digestive tract reconstruction methods after proximal gastrectomy

Proximal gastrectomy, the surgical treatment of gastric upper adenocarcinoma or early esophagogastric junction adenocarcinoma, has received more and more attention. However, pathophysiological changes after proximal gastrectomy lead to a high risk of severe gastroesophageal reflux or reflux esophagitis, such as loss of mechanical anti-regurgitation barrier and receptive relaxation, decrease of peristalsis of remnant, incoordinate contraction, pylorus spasm, which limit its widespread use. Dozens of digestive tract reconstruction methods with different anti-reflux design have been reported in recent years. These strategies could be divided into 3 categories: buffer zone method, reconstruction of mechanical anti-regurgitation barrier, speeding up gastric emptying. The authors analyze the pathophysiological changes related with gastroesophageal reflux after proximal gastrectomy from the perspective of anatomy and phy-siology,summarize the advantages and disadvantages of anti-regurgitation methods, and look forward to the development trends in the future.