Cancer arising in the gastric stump. Occurrence following resection for benign peptic ulcer disease

Two patients developed adenocarcinoma of the gastric stump 20 to 30 years following gastric resection for benign peptic ulcer disease. The bulk of the medical literature supports a small but definite increased incidence with a latency period of 20 years or more. The risk is greatest following operations that lead to greater reflux of bile and pancreatic juices into the gastric remnant. The diagnosis may be inapparent by upper gastrointestinal tract roentgenograms, and changes may not even be obvious at endoscopy. Five-year survival rates are low (2% to 4%). Because the prognosis is poor once the disease is diagnosed, the high-risk patient should be considered for intermittent endoscopic surveillance.