INTERPRETATION OF POSTVAGOTOMY ENDOSCOPIC CONGO RED TEST-RESULTS IN RELATION TO ULCER RECURRENCE 5 TO 12 YEARS AFTER OPERATION

BACKGROUND: The aim of the present study was to estimate, after vagoto my, the location and extension of residual vagal innervation of the ga stric corpus mucosa by using the endoscopic Congo red test (ECRT) and its relation to recurrent ulcer (RU), as well as the results of quanti tative gastric acid tests: basal acid output (BAO), maximal acid outpu t (MAO), and nocturnal acid output (NAO). METHODS: A total of 271 cons ecutive vagotomized duodenal ulcer (DU) patients were studied 5 to 12 years (mean 8 years) after the operation, In all cases gastroscopy and ECRT were performed simultaneously. ECRT was considered positive if a red to black-blue (pH <3.0) color change of the gastric corpus mucosa occurred within the first 3 minutes, and the cases were classified as having small extension (SE), ie, one or more areas with a diameter of 1 to 30 mm, or large extension (LE), ie, 20% or move of the gastric c orpus showing residual vagal innervation, No red to black-blue changes (pH >3.0) were attributed to negative ECRT. BAO, MAO, and NAO were de termined preoperatively and postoperatively in 108 cases out of 271 an d correspond with ECRT results. RESULTS: Recurrent ulcer occurred in 1 8 out of 135 ECRT-positive and in 1 out of 136 ECRT-negative cases, RU occurred 5 times more frequently in LE than SE cases (P <0.05). The p ostoperative mean values of BAG, MAO, and NAO were significantly highe r in ECRT-positive than in ECRT-negative cases (P <0.001), and higher in LE than in SE cases (P <0.01; for NAO, P >0.05). CONCLUSION: ECRT i s a practical and reliable method in the evaluation of postvagotomy DU patients: Negative ECRT practically includes recurrent ulcer risk; po sitive ECRT of large extension is related to fivefold higher recurrent ulcer risk compared with ECRT of small extension; and ECRT reflects B AG, MAO, and NAO results and cars be used instead of them as a less ti me-consuming procedure, which is more convenient for the patient. (C) 1998 by Excerpta Medica, Inc.