Gastroscopic screening of the post-gastrectomy stomach. Relationship of dysplasia to remnant cancer.
In July 1980, an aggressive screening program for benign disease of the stomach in 163 patients at risk for carcinomatous change of the gastric remnant was instituted. All patients were at least ten years post-gastrectomy. Three gastric remnant cancers were identified during esophago-gastroduodenostomy (EGD) on 45 patients undergoing only one screening endoscopic examination during the study. One hundred and eighteen additional patients underwent two or more screening gastroscopic studies between July 1980 and July 1985. Of this group, seven patients (5.8%) had gastric biopsies showing mild to moderate dysplasia in the gastric remnant. During the period July 1985 to July 1987, these seven patients underwent two to four additional gastroscopic examinations that revealed carcinoma of the gastric remnant in two patients (28%) with progression of the dysplastic changes in three of these seven patients (42%). The post-gastrectomy interval in these seven patients ranged from 10 to 27 years with a mean of 21.5 years. This study supports the concept of neoplastic change in the gastric remnant as a function of time from initial gastric resection. EGD and biopsy are important in identifying dysplastic changes which may be harbingers of invasive carcinoma of the gastric remnant. Aggressive endoscopic screening is recommended for patients with dysplasia in order to identify gastric remnant cancer while potentially curable.
Greene
F L
FL
University of South Carolina School of Medicine, Columbia.
D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D001706:Biopsy; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D011230:Precancerous Conditions; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D013997:Time Factors