GASTRIC STUMP CANCER - WHAT IS THE RISK

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.