Patients with partial gastrectomy and Barrett esophagus are in higher risk to develop esophageal adenocarcinoma than those with Barretts without gastrectomy.

BACKGROUND/AIMS: Duodenogastric reflux is a possible risk factor for esophageal adenocarcinoma (CA) development. Gastric surgery that destroys or distorts the pylorus is a good model to study the effects of duodenogastric reflux. To define the consequences of gastrectomy in patients with Barrett esophagus (BE). METHODOLOGY: Records of all BE/CA patients examined in Blackpool-Wyre-Fylde area were reviewed. All surviving patients completed validated questionnaires. RESULTS: Gastrectomy was more prevalent in CA patients (14 (3.6%) BE vs. 15 (13.3%) CA, p=0.0002). Partial gastrectomy was more prevalent in CA patients, (7 (1.8%) BE vs. 10 (8.8%) CA, p=0.0004), while there was no difference in total gastrectomy between the two groups. Persistence of H. pylori infection after gastrectomy and smoking were more frequent among CA patients with gastrectomy. Mean follow-up time in patients with prior gastrectomy was 78 (SD=76.4) months for BE patients and 119.3 (SD=72.9) months for CA patients (p=0.07). In logistic regression analysis gastrectomy, in addition to old age, long-term reflux, absence of hiatal hernia and H. pylori infection were risk factors for CA. CONCLUSIONS: Gastrectomy and especially partial gastrectomy was more prevalent in CA patients.

What information should be given to patients undergoing therapeutic endoscopy?

Doctors and other health professionals should always offer information to patients about the risks, benefits and alternatives to the treatment or examination proposed. Such information should be offered in a timely fashion and in a form understandable to the patient. The professional should assess the patients' ability to comprehend and to make a judgement if their consent is to be valid. Patients occasionally may refuse the offer, but this refusal does not exonerate the doctor from pointing out serious hazards. Discussions of risk must be made in a friendly manner and the patient's questions invited.