Early detection of gastric remnant carcinoma. The role of gastroscopic screening
F. L. Greene
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 routine gastroscopy leads to earlier detection and a higher
rate of resectability if gastric remnant carcinoma is found; yearly
screening should be performed after a ten-year postresection interval; and
gastroscopic biopsy is more accurate than upper gastrointestinal tract
barium contrast studies and should be used preferentially to identify
gastric remnant carcinoma.
