RISK-EVALUATION OF POSTVAGOTOMY ULCER RECURRENCE BY USING ENDOSCOPIC CONGO RED TEST AND GASTRIC-SECRETION TESTS

BACKGROUND/AIMS: To evaluate the usefulness of the endoscopic Congo re d test (ECRT), sind to compare sensitivity and specificity of differen t tests in the discrimination of cases with high risk for postvagotomy recurrent ulcer (RU). METHODOLOGY: In 271 consecutive postvagotomy du odenal ulcer patients the endoscopic Congo red test (ECRT) was used 5- 12 years after vagotomy. Further, 39 patients out of 271 were selected and classified into two groups: A - 13 ECRT positive cases with RU, B - 26 controls without RU (13 ECRT positive and 13 ECRT negative cases ). Basal acid output (BAO) maximal acid output (MAO), and nocturnal ac id output (NAO) were determined pre- and postoperatively, the serum pe psinogen I (S-PGI) and insulin test were estimated postoperatively. RE SULTS: Positive ECRT had 95% sensitivity and 53% specificity for RU. S -PGI > 150 mu g/l had 54% sensitivity and 92% specificity tin ECRT pos itive cases 100% specificity). The insulin test showed 83% sensitivity and 78% specificity. The respective data for the combination of BAO > 1.5 mmol/h + NAO > 30 mmol/12h were 80% and 81%. CONCLUSION: ECRT sho uld be a primary step in estimating postvagotomy ulcer risk. In negati ve ECRT cases, the development of recurrent ulcer is unlikely. Additio nal gastric secretion studies as S-PGI or BAO+NAO or insulin test are needed only in ECRT positive cases.