Discovery of early gastric remnant carcinoma. Results of a 14-year endoscopic screening program.

Partial gastrectomy for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma, particularly in patients who are 15-20 years postresection. Using a planned protocol of routine endoscopic surveillance with biopsy, 163 patients who were at least 10 years postgastrectomy for benign ulcer disease have undergone screening flexible esophagogastroduodenoscopy (EGD) between July 1980 and August 1994. The completed study group consists of 153 patients who have been examined at least yearly over the 14-year period of surveillance. Routine biopsies from various areas of the gastric remnant have been interpreted for dysplasia or early gastric adenocarcinoma. Patients who evidenced significant dysplasia or adenocarcinoma were offered complete gastrectomy during the study. Results of this ongoing 14-year screening program revealed severe dysplasia of the gastric remnant in 13 patients (8.4%) with eventual findings of adenocarcinoma in seven of this group (54%). These seven patients underwent total gastrectomy with findings of limited disease. Six patients continue to be followed with evidence of dysplasia. During this 14-year screening program, seven patients undergoing completion gastrectomy for early gastric remnant adenocarcinoma continue to be well and free of disease. This aggressive screening program supports the concept that neoplastic change in the gastric remnant is a function of time from the initial gastric resection. Patients identified with early gastric remnant carcinoma benefit by completion gastrectomy. In addition, patients harboring dysplasia in the gastric remnant should continue to be followed in an aggressive screening protocol utilizing random biopsy.