title: Endoscopic Screening for Remnant Gastric Cancer: Points to be Considered.
abstract: OBJECTIVE
  It is difficult to detect early gastric cancer (EGC) during endoscopic surveillance because the remnant stomach is usually deformed after surgical resection and the mucosa at the gastric stump are changed due to bile reflux. In this study, we aimed to determine the characteristic endoscopic findings of cancer in the remnant stomach.
  
  
  METHODS
  Fifty-five remnant gastric cancer (RGC) patients were classified into three groups according to location and elapsed time after surgery. Among 32 RGCs that developed less than 10 years after surgery, 21 lesions were located close to the anastomosis site (recurrent cancers), whereas 11 lesions were not (residual cancers). Twenty-three cancers developed at least 10 years after surgery (newly developed cancers). The endoscopic features were compared among these groups.
  
  
  RESULTS
  Most patients (29/32, 91%) with residual or recurrent cancer developed their tumors within five years after surgery, and the proportion of EGC was 43.8% (14/32). However, 91.3% (21/23) of newly developed cancers were advanced gastric cancers. When classified according to the Japanese classification system for EGC, 71% (5/7) of the residual cancers were of the elevated type, whereas 86% (6/7) of the recurrent cancers were of the depressed type (p=0.00).
  
  
  CONCLUSIONS
  During the first 5 years after subtotal gastrectomy, endoscopists should mainly try to find depressed lesions on the anastomosis site as well as elevated lesions on the non-anastomosis site.
authors.affiliation: Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Jun Haeng
authors.initials: JH
authors.lastname: Lee
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
authors.forename: Sung
authors.initials: S
authors.lastname: Kim
authors.forename: Cheol Keun
authors.initials: CK
authors.lastname: Park