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At least 991 records · Page 55Linked to original sources
PubMed2001

Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU".

BACKGROUND: Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly. AIMS: To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres. PATIENTS: Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms. METHODS: Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection. RESULTS: A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction. CONCLUSIONS: Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.

Barrett Esophagus↗
PubMed1999

Usefulness of early serial measurement of specific and total immunoglobulin E in the diagnosis of gastro-allergic anisakiasis.

BACKGROUND: Sensitization to Anisakis simplex (A. simplex) has been documented to produce severe allergic reactions following ingestion of mainly raw or under-cooked parasitized fish. False positive skin prick tests (SPT) or specific IgE against this nematode and cross-reactivity restricts diagnosis. Gastric anisakiasis and gastro-allergic anisakiasis occur if fish is parasitized by live A. simplex OBJECTIVE: To investigate if serial serological analysis could be useful in the diagnosis of acute parasitation by this nematode. METHODS: We included 41 patients who experienced an allergic reaction and/or abdominal symptoms after ingestion of raw or undercooked fish and displayed specific IgE against A. simplex. Total and specific IgE were determined two times: in the 24-h period after onset of clinical symptoms and after 1 month. SPTs were performed against A. simplex and implicated fish. A fibre optic gastroscopy was performed in 22 patients. RESULTS: Median total IgE was 80.0 (Interquartile range [IQR] 41.5-186.5) kU/L in the first evaluation and 247.0 (IQR 96.5-649.5) kU/L after 1 month. Median specific IgE against A. simplex was 11.4 (IQR 7.1-33.5) kU/L in the first 24 h and 36.8 (IQR 19.5-79.5) kU/L after 1 month. A rise of total IgE was observed in 35 of 41 patients (P<0.00001) and a rise in specific IgE against A. simplex in 37 of 41 patients (P<0.00001). Mean percentage increment was 392% (215-571%; 95% confidence interval [CI]) for total IgE and 339% (177-502%; 95% CI) for specific IgE. In nine of 22 gastroscopic examinations at least one larva, identified as A. simplex, could be detected by our microbiology service. In this group (n = 9) a rise of total and specific IgE was detected in eight patients (89%) (P = 0.02). CONCLUSIONS: We consider a rise of total and specific IgE in the first month after an allergic reaction as a useful tool in the diagnosis of gastro-allergic anisakiasis (together with patient's history), even if the parasite cannot be seen with fibre optic gastroscopy. The important rise of total and specific IgE against A. simplex can be considered as a reaction induced by the live parasitizing larva in the context of a polyclonal immunological stimulation.

Adult↗
PubMed1975

[Is there a risk of transmitting hepatitis by gastroduodenoscopy?].

Among 211 patients undergoing gastroduodenoscopy five had been carriers of Australia antigen. The same instrument had been used on all, and follow-up examination was carried out two and four months after the gastroscopy. Twelve patients died during the follow-up period of their original disease. Two additional patients became Australia-antigen positive. One of these had liver cirrhosis. In the other, surgery with multiple infusions of albumin had been carried out after gastroscopy and could have been the cause of the Australia-antigen transmission. No proven case of hepatitis transmission occurred in this group of patients.

Follow-Up Studies↗
PubMed2003

[Socioepidemic analysis of sources of information and medical care for a subpopulation of female and male participants in a nationwide informative campaign in Germany on "Danger Signal: Heartburn"].

Whilst the prevalence of gastroesophageal reflux is increasing, most people are unaware of its possible consequences. Therefore, in Autumn 2000 a nationwide information campaign was launched on the symptoms of gastroesophageal reflux and its possible treatments. One part of the information campaign was a telephone hotline which was followed by an interview by phone or a mailed questionnaire. The objective of this was to find out more about the people concerned and their complaints. The subjects of both data sets were on average 53 respectively 57 years old, half of them were female and over 60 % had had heartburn for more than two years. The interview showed that 53 % took notice of the hotline by a press release. The interviewed persons gathered information in general about health-related issues primarily from newspapers and TV reports and from their physician. 81.7 % of the questionnaire sample had already at least one gastroscopy. Another 9.5 % made use of medical services because of their complaints in the last year. 8.8 % used exclusively over-the-counter medication for relief from their complaints. These three groups of different degrees of utilisation differed in respect of age, intensity and duration of the symptom heartburn and lifestyle-factors such as smoking. Those who had a gastroscopy were older, symptoms were more prolonged, more severe, more often and comprised a wider range of symptoms and less cigarette consumption. The analysis of both samples showed that the telephone hotline was used mainly by people who had had their symptoms for a long time and had already been in medical care. The chosen means of information stated by the sample indicate that media are prominently involved in disseminating information and educating the public.

Age Factors↗
PubMed2003

Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample.

BACKGROUND AND STUDY AIM: Various gastroscopic features may be interpreted as signs of gastritis, but the significance of such features in relation to histomorphology is uncertain. The aim of this study was to determine how macroscopic findings were related to histomorphological changes and the presence of Helicobacter pylori in the gastric mucosa, in a sample of the general population. SUBJECTS AND METHODS: 488 adult individuals, randomly selected from a general population, were screened with gastroscopy and biopsy. The macroscopic features recorded were erythema (diffuse, spotty, linear), erosions, absence of rugae in the gastric corpus, and presence of visible vessels. Gastritis was classified microscopically according to the Sydney system. The presence of H. pylori was determined histologically and using the urease test on fresh biopsy specimens. RESULTS: The sensitivity and specificity of absence of rugae for moderate to severe atrophic gastritis in the gastric corpus were 67 % and 85 %, respectively. Corresponding values for severe atrophy were 90 % and 84 %. The sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy in the corpus were 48 % and 87 %, and for severe atrophy the values were 80 % and 87 %, respectively. Considering the antrum, the sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy was 14 % and 91 %, respectively. With regard to chronic inflammation (moderate to severe in the corpus or antrum), none of the features, alone or in combination, showed a sensitivity of more than 56 %. No endoscopic features (alone or in combination) showed a sensitivity of more than 57 % for H. pylori infection. CONCLUSIONS: Except for the absence of rugae and visible vessels in the gastric corpus, macroscopic features as observed during gastroscopy are of very limited value in the evaluation of whether or not gastritis or H. pylori infection are present. This is in accordance with most previous studies in patient populations, and it must be emphasized that the diagnosis of gastritis should be based on histological examination of the gastric mucosa.

Adult↗
PubMed2003

A gastric hyperplastic polyp observed endoscopically before and after autoamputation.

Autoamputation of a gastric polyp is a relatively rare phenomenon and its precise mechanism is unclear. To learn more about the mechanism(s) involved, it is important to observe a polyp just before and just after its disappearance. We report a case of a gastric polyp that was observed endoscopically just before and then just after autoamputation. A 61-year-old woman with a thumb-sized, pedunculated hyperplastic polyp in the gastric antrum visited our institution for investigation of hematemesis. She was being treated with oral hypoglycaemic drugs for diabetes mellitus but was not taking any other medicine around that time. Emergency gastroscopy revealed a bleeding point near the polyp; gastroscopy the next day revealed that the polyp had disappeared. It was concluded that autoamputation of a gastric polyp may follow gastric injury induced by diabetes mellitus or oral antidiabetic drugs.

Diabetes Mellitus↗
PubMed2004

Nonattendance at outpatient endoscopy.

BACKGROUND AND STUDY AIMS: Nonattendance at outpatient endoscopy leads to inefficiency and delay in diagnosis. We aimed to identify factors associated with failure to attend outpatient gastroscopy and colonoscopy. PATIENTS AND METHODS: We carried out a retrospective audit of nonattendance at outpatient endoscopy over a 12-month period at our tertiary hospital endoscopy unit. Attending patients on the same endoscopy list were used as controls. Patient charts and referral letters were reviewed. The information collected included referral source, time between referral and procedure, indication and type of procedure, reason for nonattendance and history of previous endoscopy. Following the audit a trial of telephone reminders was implemented over a 3-month period. RESULTS: From 2157 outpatient procedures that were scheduled, 263 nonattendees (12.2 %) were identified with 261 controls. Of the nonattendees, 109 (41 %) did not attend for colonoscopy, 121 (46 %) did not attend for gastroscopy and 33 (13 %) failed to turn up for combined procedures. Monday was the most common day of the week for nonattendance (40 % of nonattenders). Nonattendees were younger (46 +/- 14 vs. 55 +/- 16, P < 0.001), less likely to be referred from a gastroenterologist ( P < 0.001) or private practice ( P = 0.02) and more likely to be referred from the emergency department ( P = 0.007). Subsequent to this, a 3-month period of telephone reminder reduced nonattendance rates from 12.2 % to 9 % ( P = 0.03). CONCLUSIONS: Younger patients scheduled for outpatient endoscopy on Mondays who are not referred by a gastroenterologist or private physician are more likely not to attend. These patients should be targeted for interventions designed to increase attendance. Telephone reminders have a modest effect on reducing nonattendance rates.

Adult↗
PubMed2004

[Chronic upper abdominal pain without improvement after using proton pump inhibitors].

HISTORY AND CLINICAL FINDINGS: A 57-year-old woman was admitted to our hospital because of relapsing, therapy-resistant pain, predominantly in the upper abdomen. The symptoms began 6 years previously, after a resection of parts of the small intestine for an ileus of unclear cause. Subsequently 11 (!) gastroscopies showed repeatedly gastritis and Helicobacter pylori- negative gastric and/or small intestinal ulcers which were treated with proton pump inhibitors. This led to no significant improvement of the complaints and produced no healing. DIAGNOSTIC FINDINGS AND THERAPY: Gastroscopy showed, at the transition of the gastric fundus to the corpus, an area with multiple, fibrin coated ulcers. Histologically an active, chronic gastric ulcer was seen, with perifocally dense inflammatory infiltration by predominantly eosinophils. In the colon these histological findings, although clearly less pronouncedly, were also seen i.e. an eosinophilic gastroenteropathy. This was initially treated with 60 mg/day prednisone. Under this treatment she became completely symptom-free. After a dose reduction to 5 mg prednisone daily the symptoms occurred again. Thereupon long-term immunosuppressive therapy with 100 mg azathioprine daily was introduced. Regular clinical and endoscopic monitoring showed a complete remission of the ulcers and no complaints after 1.5 years. CONCLUSION: Our case report shows that in patients with uncharacteristic abdominal pain and gastric ulcers, which improve inadequately under the usual medication such as proton pump inhibitors, less common illnesses must be considered. Despite the rarity of eosinophilic gastroenteropathy the exact (histological) diagnosis plays an important role, because a specific therapy with corticosteroids and/or azathioprine can induce improvement of the symptoms.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1980

[Proof of the jejunogastric bile reflux after BII partial gastrectomy using 99mTc diethyl-IDA (author's transl)].

A history was obtained and barium meal and gastroscopy performed on 42 patients after a Billroth II partial gastrectomy. In order to demonstrate and quantify jejuno-gastric bile reflux, hepato-biliary sequential scintigraphy was carried out using 99mTc diethyl-IDA. The method has advantages over conventional techniques in that it is easy for the patient and demonstrates reflux both when the stomach is empty and full. The result showed that all patients who had evidence of inflammatory changes or ulcers on barium meal or gastroscopy had evidence of reflux.

Adult↗
PubMed1994

[Treatment of an intermittent stomach volvulus using gastropexy via percutaneous endoscopic gastrostomy].

A 72-year-old woman had been experiencing upper abdominal pain and vomiting for 2 years. On physical examination the abdomen was swollen and pressure sensitive. She had a leukocytosis (11,400/microliter) and hypokalaemia (3.6 mmol/l). X-ray films of the chest and abdomen revealed a large gastric air-bubble with two fluid levels of different height and an elevated left diaphragm, findings which suggested gastric volvulus. Most of the fluid was evacuated via a nasogastric tube. The stomach interior was difficult to examine by gastroscopy: it was only after withdrawal of the gastroscope from the duodenum that a normal gastric architecture was demonstrated, the volvulus apparently having been reduced during the gastroscopy. The gastric mucosa showed ulcerations and erosions. Gastropexy by gluing together the peritoneal layers was undertaken via dual percutaneous endoscopic gastrostomy. The catheters were removed after 4 weeks when the ulcerations had healed. The patient has been free of symptoms for more than a year so far.

Aged↗
PubMed1993

[Is Helicobacter pylori gastritis a macroscopic diagnosis?].

In a prospective study, gastroscopy and biopsies from the gastric antrum and body were undertaken in 100 consecutive patients (67 women, 33 men; mean age 58.6 [11-90] years) with unknown Helicobacter pylori status. None had been on any bacteria-suppressing drugs. Main indications for gastroscopy were upper abdominal pain, dyspepsia, emesis and anaemia of unknown cause. The macroscopic criteria for the diagnosis of H. pylori gastritis were the presence of at least one of the following signs: (1) chronic antral erosions; (2) goose-pimple-like appearance of the antral mucosa; (3) spotty erythema in the antrum; (4) complex changes of the antral mucosa with both bizarre reddening and pale areas; and (5) increased areolar markings and diffuse or fine-spotty erythema in the mucosa of the body of the stomach. Four biopsies each from the antrum and body were examined with the urease quick-test, microscopically as smears, specific culture and histology as reference methods. 60 patients had H. pylori gastritis, recognized macroscopically in 59 (sensitivity 98.3%). A false-positive diagnosis was made in 10 of 40 H. pylori-negative patients (specificity 75%). The positive predictive value of macroscopic diagnosis was 85.5%, the negative predictive value 96.8%.

Adolescent↗
PubMed1990

[Anxiety before gastrointestinal endoscopy--a significant problem?].

98 consecutive patients (40 men, 58 women; mean age 49 [17-83] years) who had been referred for outpatient gastroscopy or colonoscopy were questioned beforehand regarding their anxiety about the procedure, its causes and how it could be dispelled. Two thirds of them (67%) stated that they felt anxiety about the investigation; almost half of them (46%) felt very great or "terrible" anxiety. 55% of the patients had been fully informed about the nature of the procedure. 69% of the women and 48% of the men had previously experienced gastroscopy or colonoscopy. The reasons for their anxiety were varied. One quarter of those questioned (24%) had had unpleasant experiences during previous endoscopies; others had been alarmed by rumours about endoscopy (22%), and some were less worried about the procedure itself than about what it might reveal (24%). Almost two thirds (63%) wanted a tranquilizing injection. Other methods for dispelling anxiety, such as detailed information about the procedure (21%), a calm, relaxed atmosphere (19%) or the presence of a relative at the endoscopy (7%) were claimed for in a limited way. However, 37% very much wanted to watch the endoscopy on the television monitor. The findings show that the number of patients who experience anxiety before undergoing endoscopy is alarmingly great, and that more energetic measures are necessary to relieve their fears and worries.

Adolescent↗
PubMed2001

First endoscopic-histologic follow-up in patients with body-predominant atrophic gastritis: when should it be done?

BACKGROUND: Body-predominant atrophic gastritis is considered a risk factor for gastric cancer and carcinoid. Timing of follow-up for patients with this disorder has not been defined. This study was undertaken to determine the optimal time for the first endoscopic/histologic follow-up in patients with body-predominant atrophic gastritis. METHODS: Forty-two patients with body-predominant atrophic gastritis were randomly assigned to 1 of 2 follow-up intervals: group A (n = 22) at 24 months and group B (n = 20) at 48 months. At baseline and follow-up patients underwent gastroscopy at which biopsies were obtained from the antrum and body for histopathology and evaluation for enterochromaffin-like cells. RESULTS: In group A patients, 2 antral hyperplastic polyps (9.1%) were present at baseline and 4 antral hyperplastic polyps (18.2%) were found at follow-up. In group B patients, baseline gastroscopy revealed 2 antral hyperplastic polyps (10%) and follow-up 2 antral hyperplastic polyps (10%) and 1 carcinoid tumor (5%) in the body. Atrophy and intestinal metaplasia scores in gastric body and antral mucosa in both groups did not change significantly between baseline and follow-up, except an increase in antral mucosa atrophy in group B patients (p = 0.02) was revealed. CONCLUSIONS: The results of this study indicate that performing the first follow-up in patients with body-predominant atrophic gastritis need not be earlier than at 4 years after diagnosis. This interval is satisfactory for detection of potential neoplastic lesions.

Adult↗
PubMed2000

Gastroduodenal tolerance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study.

BACKGROUND: Clopidogrel is a new antiplatelet agent that offers increased protection over aspirin in preventing vascular ischaemic events in patients with symptomatic atherosclerosis. In a large, randomized, international study of clopidogrel and aspirin (n = 19,185 patients) clopidogrel was associated with a lower incidence of gastrointestinal adverse events, including gastrointestinal haemorrhage and hospitalizations because of gastrointestinal haemorrhage. The aim of the study was to determine whether macroscopic differences in the gastric mucosa between aspirin- and clopidogrel-treated subjects could be detected by gastroscopy after short-term treatment. METHODS: Thirty-six healthy volunteers were randomized in a double-blind, double-dummy, parallel design, to 75 mg/day of clopidogrel or 325 mg/day of aspirin for 8 days. Gastroscopy was performed at base line before administration of study drug and directly after treatment completion. Gastroduodenal effects were measured in accordance with a modified Lanza scale. RESULTS: At base line no difference between the groups was detected (median Lanza score, 0.0 in both groups). At the end of treatment the aspirin group showed a median score of 7.5, and the clopidogrel group showed an unchanged median score of 0.0 (P < 0.001). In the aspirin group 13 individuals reported 19 adverse events versus 8 individuals and 13 adverse events for clopidogrel, with approximately half of the adverse events being gastrointestinal in each group. No serious adverse events were reported. CONCLUSION: In contrast to aspirin, short-term treatment with clopidogrel does not induce macroscopic changes in the gastroduodenal mucosa. The study results show that in patients without gastroduodenal disease clopidogrel, but not aspirin, does not induce any gastroscopically evident erosions during short-term treatment.

Adult↗
PubMed1999

Therapy and diagnostic tests used for Helicobacter pylori infection in the Scandinavian countries in 1998.

BACKGROUND: We wanted to ascertain how Helicobacter pylori infection is managed in Scandinavia. METHODS: A one-page questionnaire with seven questions was mailed in April 1998 to 1718 gastroenterologists in Finland, Denmark, Norway, and Sweden (excluding Swedish surgeons). RESULTS: The questionnaire was returned by 36%. Antimicrobials were used by 99% for peptic ulcer associated with H. pylori, by 67% for mucosa-associated lymphoid tissue lymphoma, by 27% before long-term therapy with a proton-pump inhibitor (PPI), by 16% for non-ulcer dyspepsia, by 11% for reflux disease, and by 11% for other indications. In Finland several conditions other than ulcer were treated more frequently than in the other countries. The commonest primary therapy is PPI triple therapy (94%), followed by bismuth-based (11%), 'other' (2%), and PPI dual therapy (0.2%). Primary bismuth-based therapy was almost completely limited to Norway. The commonest secondary therapy for failures was also PPI triple therapy (71%), followed by bismuth-based (41%), 'other' (10%), and PPI dual therapy (1%). Clarithromycin for primary therapy was used much less frequently in Finland than in the other countries. Follow-up to ascertain whether eradication is successful was done always or often by 90% in Finland, 63% in Norway, 62% in Sweden, and 21% in Denmark and by 61% of the internists and 42% of the surgeons. The commonest method to confirm eradication was gastroscopy (69%), followed by the breath test (52%) and serology (11%). CONCLUSIONS: In Scandinavia H. pylori associated with peptic ulcer disease is treated with antimicrobials by virtually all gastroenterologists. PPI triple therapy is the commonest regimen for primary and secondary eradication. PPI dual therapy has essentially disappeared. Fifty-four per cent confirm eradication always or often, with gastroscopy being the commonest method.

Antacids↗
PubMed2004

Clinicopathologic features of asymptomatic gastric adenocarcinoma patients in Korea.

OBJECTIVE: The aim of this study was to analyze the characteristics of patients diagnosed with gastric adenocarcinoma without the presence of symptoms and to evaluate the usefulness of screening programs for gastric cancer in Korea. METHODS: We retrospectively analyzed the characteristics of 1277 gastric adenocarcinoma patients at Seoul National University Hospital (SNUH) (665 in 1996; 612 in 2001) by dividing them into two groups according to the presence or absence of symptoms (symptomatic group vs asymptomatic group). RESULTS: The proportion of asymptomatic patients increased from 1996 (4.7%) to 2001 (17.2%) (P < 0.001). Gastroscopy was the most commonly used screening tool (77.4% in 1996, 95.2% in 2001). The proportion of early gastric cancer (EGC) in the asymptomatic group was higher than in the symptomatic group (74.2% vs 25.9% in 1996, 78.1% vs 35.7% in 2001) (P < 0.001). The curative operation rate was significantly higher in the asymptomatic group. The asymptomatic group had a higher 5-year survival rate (87.7%) than the symptomatic group (51.6%) (P < 0.01). Complementary data from a screening program at the SNUH showed that 19 gastric cancer cases (0.76%) were detected out of 2501 endoscopic examinations; of these, 78.9% (15/19) were early gastric cancer cases, which is in agreement with our results. CONCLUSION: Patients with asymptomatic gastric adenocarcinoma had fewer advanced lesions, a greater chance for curative operation and a higher survival rate than symptomatic patients. An increase in the number of asymptomatic patients contributed to the increase in overall EGC from 1996 to 2001. These results seemed to support the usefulness of gastroscopy as a screening test for gastric cancer in Korea, where the incidence of gastric cancer is high.

Adenocarcinoma↗
PubMed1996

Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program.

SUMMARY BACKGROUND DATA: Partial gastrectomy for benign peptic ulcer disease is associated with an increased risk of adenocarcinoma of the gastric remnant, especially in patients who are at least 15 years' postgastrectomy. Increasing evidence of mucosal dysplasia is noted on random gastric biopsy and may serve as a histologic marker in the identification of early cancer of the gastric stump. METHODS: From an initial group of 233 patients who underwent gastrectomy for benign peptic ulcer disease between 1960 and 1975, 163 patients began yearly flexible gastroscopy and random mucosal biopsy. Routine histologic studies identified either normal or dysplastic epithelium as well as adenocarcinoma. An average of eight biopsies were taken per endoscopic study. All endoscopic studies were performed by surgical residents under the supervision of one surgical attending. RESULTS: From July 1980 to June 1995, 145 patients completed annual gastroscopy and random biopsy. A total of 2287 endoscopic studies were performed. Fifteen patients were found to have severe dysplasia. Nine (60%) had associated microscopic evidence of adenocarcinoma. Four additional patients had macroscopic adenocarcinoma on endoscopic examination. All 13 patients with cancer were asymptomatic. Six patients continue surveillance who display moderate-to-severe dysplasia alone. The 13 patients with carcinoma underwent completion gastrectomy (R2 nodal dissection) with no evidence of cancer found beyond the gastric wall. These patients averaged 29 years since their original partial gastrectomy. OBJECTIVE: A prospective screening program for gastric remnant cancer was begun to assess the ability to discover early neoplastic changes on random biopsy and to make treatment decisions regarding the efficacy of completion gastrectomy after discovery of carcinoma. CONCLUSIONS: Aggressive annual screening using flexible endoscopy and multiple random biopsy may discover cancer in the gastric remnant and can lead to completion curative gastrectomy in asymptomatic people. Patients who are at least 20 years postpartial gastrectomy for benign disease should be considered for annual endoscopic surveillance.

Adenocarcinoma↗