Patients who have undergone partial gastric resections are at an incre
ased risk for the development of cancer in the gastric remnant. The ov
erall risk increases over time and is higher in patients with an initi
al diagnosis of gastric rather than duodenal ulcer, in men and followi
ng partial gastrectomy with Billroth II reconstruction. The site of tu
mor growth is predominantly in the anastomotic area, but may occur any
where in the stump. Enterogastric reflux, achlorhydria, bacteria overg
rowth, and Helicobacter pylori appear to be the major factors involved
in the etiopathogenesis of the gastric stump cancer. Surveillance of
these patients with endoscopy and multiple biopsies may provide the me
ans to diagnose tumors at an early stage, but the cost-benefit ratio o
f surveillance requires further study. Despite the magnitude of altera
tions in gastric stump mucosa? unfortunately, at this time we do not h
ave good predictors of patients who will develop a cancer.