Gastroenterostoma after Billroth antrectomy as a premalignant condition.
Gastric stump carcinoma (GSC) following remote gastric surgery is widely recognized as a separate entity within the group of various types of gastric cancer. Gastrectomy is a well established risk factor for the development of GSC at a long time after the initial surgery. Both exo- as well as endogenous factors appear to be involved in the etiopathogenesis of GSC, such as achlorhydria, hypergastrinemia and biliary reflux, Epstein-Barr virus and Helicobacter pylori infection, atrophic gastritis, and also some polymorphisms in interleukin-1β and maybe cyclo-oxygenase-2. This review summarizes the literature of GSC, with special reference to reliable early diagnostics. In particular, dysplasia can be considered as a dependable morphological marker. Therefore, close endoscopic surveillance with multiple biopsies of the gastroenterostomy is recommended. Screening starting at 15 years after the initial ulcer surgery can detect tumors at a curable stage. This approach can be of special interest in Eastern European countries, where surgery for benign gastroduodenal ulcers has remained a practice for a much longer time than in Western Europe, and therefore GSC is found with higher frequency.
Department of Pathology, University Medical Centre, Utrecht, 3584 CX Utrecht, The Netherlands. r.sitarz@umlub.pl
Robert
R
Sitarz
Ryszard
R
Maciejewski
Wojciech P
WP
Polkowski
G Johan A
GJ
Offerhaus
D001706:Biopsy; D055088:Early Detection of Cancer; D018530:Gastric Stump / Q000473:pathology*; D005763:Gastroenterostomy / Q000009:adverse effects*; D005773:Gastroscopy; D006801:Humans; D011230:Precancerous Conditions / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D013276:Stomach Ulcer / Q000601:surgery*; D013997:Time Factors