Abstract
In order to diagnose early stump carcinoma 20 years after Billroth II resection an endoscopic follow-up was performed in 214 of 459 patients primarily resected for benign ulcer disease. A further aim was to study the localization of macro- and microscopic mucosal changes. Three patients with stump carcinoma were found among 140 patients dead at the follow-up. Six carcinomas, among which two were early carcinomas, were diagnosed in the follow-up group. All carcinomas were found in men. Moreover, 1 patient with multifocal precancerous alterations of the stoma, 2 with tubular adenoma, and 20 with regenerative polyps (9.3%) were found. No significant difference was found in the ratio of original duodenal-gastric ulcer in patients with carcinoma or polyps when compared to other patients. The macro- and microscopic changes were most severe in the stoma, which seems to be a preferential site for carcinoma. The histological changes, however, did not differ in patients with or without carcinoma and polyps. At present no evidence has been found indicating that histological findings such as chronic atrophic gastritis, intestinal metaplasia, or cystic dilatation of the gastric glands, can be regarded as an early indicator of malignant transformation. In order to achieve early detection of stump carcinoma, repeated gastroscopic examinations are recommended from 10 to 15 years after surgery.
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