胃切除後残胃癌の内視鏡診断

Remnant gastric cancer (RGC) can develop in patients who have undergone curative resection for gastric cancer and in those who have undergone gastrectomies for benign disorders such as peptic ulcer disease. Routine endoscopic surveillance is recommended for early detection of cancer at the anastomosis site or within the remnant stomach. However, endoscopy in postgastrectomy patients may be challenging because of the limited space of the remnant stomach, deformity at the anastomosis site, interference from retained food material, and inflammation associated with recurrent bile reflux. The interval and location of RGC occurrence may vary depending on the type of primary disease, the stage of the initial cancer, and the reconstruction method used. Elevated lesions are the most common finding in early stage RGC in the remnant stomach, whereas ulceroinfiltrative lesions are more frequently observed in advanced RGC at the anastomosis site. Therefore, meticulous examination of the gastric mucosa at both the anastomosis site and in the remnant stomach is crucial for the early detection and diagnosis of RGC in post-gastrectomy patients.