Introduction

1. Numerous older studies have reported the association between Billroth II (BII) and Gastric Cancer / Gastric Stump Cancer (GCa) 20 -30 years post surgery. For example: in a meta-analysis of 28 articles published in 1990 (1) the Relative risk of GCa after 20-30 years we estimated as 1.6. Of note in this study all BIIs were done for ULCER DISEASE (think H. Pylori.) The Mini-Gastric Bypass includes a BII gastro-jejunostomy and some critics of the operation have raised the risk of gastric cancer in these patients. The purpose of this study is to review the current knowledge on GCa, BII and the risk of GCa following BII in 2013. Introduction Methods Results -Some studies *Do* show slight Increased risk of GCa 20-30 years after B2 (RR 1.5), In these studies: B2 performed to Rx Ulcer; Ulcer Increases Risk GCa (H. Pylori) Ulcer and H. Pylori increase risk of GCa. Increased compared to population related H.Pylori/Ulcer Magnitude Risk (Confusion between statistically significant and Clinically relevant) In studies that *DO* increased risk RR mean = 1.5 Comparison to 50 g of processed meat (=1 “Hot Dog”) eaten for 6 years increased risk RR mean = 2.5 To Restate 6 yrs of “Hot Dog” diet more deadly than 30 yrs of BII. Gastroenterologists Generally Ignore BII -Endoscopic screening of B2 patients is generally *Not* recommended; REASON because of Low Risk. Follow-up study of 1000 patients, 22-30 year follow-up 196 endoscopy and biopsy No Cancer of the gastric remnant seen, Endoscopic screening will be “unrewarding” -General, Trauma and Oncologic surgeons Routinely use the B2. In 2007 16,000 B2 procedures performed in USA. The B2 is still the most widely used reconstruction after distal gastric resection (Billroth II in use for over 100 years & over 1, 400 reported papers on Medline.) Conclusions Risk Gastric Cancer (GCa) after BII low/not clinically significant. GCa rates Declining Rapidly, GCa Preventable Rx H.Pylori, Avoid Etoh, Tobacco, Processed meat/food, encourage Fresh Fruit Veges. Many studies show no increased risk of GCa after BII, those that do may be related to H.Pylori infection of ulcer, Not BII. Risk is so low most GI Docs do not recommend routine screening for follow up (except China/Japan) General Trauma and Oncologic surgeons continue to use the BII routinely as part of their surgical practice. The recent and distant literature on the causes prevention and outcomes of GCa, BII, the use of BII and the relation between GCa and BII. Dr. Rutledge, Tel: +1-702 714 0011, E-mail: drr@clos.net Please Note: I have 18 presentations (14 oral and 4 posters) If I am not present please email or Call me and I will be right back. DrR RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS Results -GCa rates are declining rapidly around the world. The incidence of gastric cancer in the United States has Decreased four-fold since 1930, Approximately 7 cases per 100,000 people. GCa mostly affects elderly. Mean age of when diagnosed is 70. Two thirds 65 or older. -GCa Cause, primarily easily modified environmental factors; Diet, Lifestyle factors & H. Pylori; Prevention: Avoid Etoh, Smoking, Processed/Salted meats and foods; Encourage high intake of fruits & vegetables & Rx H. Pylori. -Many Large scale Studies document No Increased Risk in GCa after BII. Mayo Clinic Study; 338 Billroth II patients Followed 25-years, 5,635 person-years, Only 2 Cancers in 5,000+ pt years of Follow Up. Predicted 2.6 cancers (relative risk 0.8) AND Study Published 1983 = GCa Declined by 50% so 2013 risk GCa 1/5,000 yrs. Lower risk in BII patients!