Endoscopic screening for premalignant changes 25 years after gastrectomy: Results of a five-year prospective study

Abstract

Sixty-three partial gastrectomy patients an average 20 years after surgery were reviewed by endoscopy and biopsy in 1977. No cases of invasive carcinoma were found. The patients were then divided into two groups. Those with moderate epithelial dysplasia (13 patients) were reviewed at 6-12 monthly intervals. One patient developed severe dysplasia but none developed an invasive carcinoma. The remaining patients with either no or mild dysplasia were offered endoscopy after 5 years and 24 agreed. Of the 12 patients with no dysplasia at the outset: 5 still had no dysplasia 5 years later, 3 had mild dysplasia and 4 now had moderate dysplasia. There were 12 with mild dysplasia at the first endoscopy, 9 remained unchanged at the review and 3 had moderate dysplasia. If dysplastic changes in gastric mucosa are pre-malignant, progression to invasive carcinoma would appear to be slow. Even 25 years after gastrectomy only a modest deterioration in the grade of dysplasia was found and no invasive cancer.

Gastric Stump Cancer: What Is the Risk?

“…On the other hand, patients with severe dysplasia are at high risk, and require close follow-up [17]. Findings of dysplasia on random biopsy indicate a greater likelihood of development of GSca and identify a subset of patients requiring more aggressive endoscopic surveillance [29,74]. On the other hand, it is difficult to predict the time course during which dysplasia will evolve into overt carcinoma [74].…”

“…As shown schematically in figure 1, surveillance biopsies should be taken in all areas of the remnant as multiple biopsies, especially from the stomal region [4,17,25,29]. Although the prognosis of advanced gastric stump cancer is poor, survival improves dramatically with early detection as demonstrated by endoscopic biopsy screening programs [4,17,18,79].…”

“…Radiologic examination is limited by surgical distortion and does not permit mucosal biopsy [1,8,9,31]. In the course of endoscopy, multiple biopsy specimens should be performed, since neoplasia may be present in patients with a normal macroscopic appearance and is often multicentric [17,26,[28][29][30].…”

Gastric stump mucosa: is there a risk for carcinoma?

“…A regression of mild and moderate dysplastic lesions has been described (25,34) . Findings of dysplasia on random biopsy indicate a greater likelihood of development of GSCA and identify a subset of patients requiring more aggressive endoscopic surveillance (13,22) . On the other hand, it is difficult to predict the time course during which dysplasia will evolve into overt carcinoma (13) .…”

“…Radiological examination is limited by surgical distortion. In the course of endoscopy, multiple biopsy specimens should be collected, since neoplasia may be present in patients with a normal macroscopic appearance and is often multicentric; this routine, otherwise, facilitates the diagnosis of early gastric cancer of the stump (22,25) . Endoscopic ultrasonography can accurately estimate the extent of local invasion (38) .…”