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The Role of Gastroscopic Screening

Frederick L. Greene, MD

Arch Surg. 1987;122(3):300-303.

Abstract
• Partial gastrectomy for benign ulcer disease has been associated with carcinoma in the gastric remnant. To detect formation of this cancer in patients having undergone this operation, we initiated a screening protocol using barium contrast studies, flexible gastroscopy, and biopsy. Patients were selected from a group of 233 patients who had undergone partial gastrectomy for benign disease between 1960 and 1975. In this group, operations for duodenal ulcer had been performed in 156 patients (83 Billroth I and 73 Billroth II reconstructions) and subtotal gastrectomy in 77 patients with gastric ulcer (17 Billroth I and 60 Billroth II reconstructions). From July 1980 to July 1985, 163 patients underwent gastroscopy and biopsy with a median postoperative interval of 14.6 years. Through screening, three resectable remnant carcinomas were found. We conclude that (1) routine gastroscopy leads to earlier detection and a higher rate of resectability if gastric remnant carcinoma is found; (2) yearly screening should be performed after a ten-year postresection interval; and (3) gastroscopic biopsy is more accurate than upper gastrointestinal tract barium contrast studies and should be used preferentially to identify gastric remnant carcinoma.

(Arch Surg 1987;122:300-303)

Author Affiliations
From the Department of Surgery, University of South Carolina School of Medicine, Columbia, and Surgical Service, Dorn Veterans Administration Hospital, Columbia, SC.

Footnotes
Accepted for publication Sept 19, 1986.

Read before the Tenth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Washington, DC, May 9, 1986.

Reprint requests to No. 2 Medical Park Road, Suite 402, Columbia, SC 29203 (Dr Greene).

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