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World J Gastroenterol. Jul 7, 2012; 18(25): 3201-3206
Published online Jul 7, 2012. doi: 10.3748/wjg.v18.i25.3201
Gastroenterostoma after Billroth antrectomy as a premalignant condition
Robert Sitarz, Ryszard Maciejewski, Wojciech P Polkowski, G Johan A Offerhaus
Robert Sitarz, G Johan A Offerhaus, Department of Pathology, University Medical Centre, Utrecht, 3584 CX Utrecht, The Netherlands
Robert Sitarz, Ryszard Maciejewski, Department of Human Anatomy, Medical University of Lublin, 20-950 Lublin, Poland
Robert Sitarz, Wojciech P Polkowski, Department of Surgical Oncology, Medical University of Lublin, 20-081 Lublin, Poland
G Johan A Offerhaus, Department of Pathology, Academic Medical Centre, 1105 AZ Amsterdam, The Netherlands
Author contributions: Offerhaus GJA and Sitarz R integrated the sections and wrote the manuscript; Maciejewski R and Polkowski WP revised the literature data.
Supported by An EMBO fellowship to Sitarz R
Correspondence to: Robert Sitarz, MD, PhD, Department of Surgical Oncology, Medical University of Lublin, Ul. Staszica 11, 20-081 Lublin, Poland.
Telephone: +48-81-5344313 Fax: +48-81-5322395
Received: November 10, 2011
Revised: March 2, 2012
Accepted: March 9, 2012
Published online: July 7, 2012

Gastric stump carcinoma (GSC) following remote gastric surgery is widely recognized as a separate entity within the group of various types of gastric cancer. Gastrectomy is a well established risk factor for the development of GSC at a long time after the initial surgery. Both exo- as well as endogenous factors appear to be involved in the etiopathogenesis of GSC, such as achlorhydria, hypergastrinemia and biliary reflux, Epstein-Barr virus and Helicobacter pylori infection, atrophic gastritis, and also some polymorphisms in interleukin-1β and maybe cyclo-oxygenase-2. This review summarizes the literature of GSC, with special reference to reliable early diagnostics. In particular, dysplasia can be considered as a dependable morphological marker. Therefore, close endoscopic surveillance with multiple biopsies of the gastroenterostomy is recommended. Screening starting at 15 years after the initial ulcer surgery can detect tumors at a curable stage. This approach can be of special interest in Eastern European countries, where surgery for benign gastroduodenal ulcers has remained a practice for a much longer time than in Western Europe, and therefore GSC is found with higher frequency.

Keywords: Gastric stump cancer, Gastrectomy, Risk factors, Endoscopic surveillance