Partial gastrectomy for peptic ulcer by the Krønlein method. An outpatient follow-up study 12 years later with particular reference to endoscopy with biopsy and brush cytology and to clinical-chemical and radiological results.

Forty-six patients were studied 12 years after partial gastrectomy for peptic ulcer. They had all been subjected to a standard Billroth II type operation as described by Krønlein, with emphasis laid upon the transverse position of the gastrojejunostomy. The clinical examination was supplemented by an outpatient gastroscopy with photography, biopsy and brush cytology, and by a series of blood analyses and X-ray of the gastric remnant. The general finding on gastroscopy was a slightly injected mucosa with flattened folds near the anastomosis, no or slight reflux of bile. The cytological examination revealed metaplasia in 7.5-15 per cent of the specimens, no sign of dysplasia or carcinoma. Biopsy showed severe atrophic gastritis in 0-13 per cent of the specimens, slight to moderate in 58-96 per cent, no signs of cellular atypia or irregular arrangements. Judged by the results of blood analyses a deficiency in iron, Vitamin B12 or both, was demonstrated in about 25 per cent of patients and of these more than 50 per cent were anaemic. X-ray examination showed that 70 per cent of the patients had an emptying time of the gastric remnant of 10-20 minutes. A transverse position of the anastomosis could be demonstrated in about 67 per cent. The necessity of a close follow-up of these patients is stressed.