According to the authors’ data, X-ray and endoscopic methods of investigation, performed in patients within a different period after gastrectomy, complement each other, allow identifying the early stages of postoperative recurrences, determine local pathological changes in the mucosa, making it possible to prevent the occurrence of malignancy.
Keywords: gastric polyps, postoperative gastric stump, comprehensive diagnosis, recurrence.
Introduction. Prevention of disease recurrence, including tumors, is considered as one of the areas of medical science. Nowadays, widely used X-ray and endoscopic methods of diagnostics allow visual detection of recurrent polyps in gastric stump and assessment of surrounding mucosa, including identification of early malignancy signs.
Materials and methods. The combined X-ray and endoscopic examination was performed in 40 patients with postgastrectomy stump. Stump polyps were found on X-ray only in 17 (42.5%) patients, while they were detected by gastroscopy in 23 (57.5%) patients.
Our surveyed patients underwent surgery for gastric polyposis. In spite of the early performed stomach resection, newly formed polyps were detected in stump of these patients. Single polyps were found in 25 of them, five patients had solitary polyps and 10 patients were diagnosed with multiple growths. This fact indicates that the resection of gastric polyps is not a radical operation and does not prevent a recurrence of the disease.
2-3 tissue samples were obtained from the top, body and the base of detected polyp, also from the surrounding mucosa of the stomach stump at a distance of 2-3, 4-5cm from the base of the polyp. In total, 40 patients underwent 156 biopsies of tissue specimens taken from the polyp and surrounding mucosa of the stomach stump. Morphological examination was performed for 80 removed polyps by preparation of sections. For that purpose, specimens of the gastric mucosa were dissociated on a slide, then stained by Nocht-Romanovsky method.
Results and discussion. Mucosal atrophy of stomach stump was found in 18 out of 156 biopsies, intestinal metaplasia, focal hyperplasia of the surface epithelium, glandular epithelium changes were revealed during the examination. These signs indicate precancerous changes of the mucosa that were found in 10 cases.
Further, cancer was detected against the background of polyps in eight cases during the morphological examination. Cytological examination of smears showed the presence of atypical cells, regarded as adenoma, with suspicion of malignancy.
To estimate the reliability of visual detection of polyp recurrence by endoscopy and X-ray, we compared the results with data obtained from biopsy of gastric polyps in 38 (95.0%) patients, while polyps were not detected in two (5.0%) patients. Of these patients, benign polyps were detected in 88%, malignant polyps - in 12%, of which four patients had a suspicion of stomach stump adenocarcinoma. Comparison of the results of visual inspection with the morphological structure of polyps allowed us to determine that X-ray and gastroscopic diagnosis is confirmed in 82% of patients. Malignancy was confirmed in 48.5% of patients, who had a suspicion of malignant polyps during gastroscopy. Cancer (adenocarcinoma) was revealed against the background of polyps in 27.8%, polyps were benign in 82.4% of cases, and 6% of patients had normal mucosa in the smear.
Of the 25 patients with single gastric polyps, visual diagnosis was made correctly in 96.1% of cases, while polyps were not identified in 3.9% of cases. Of five patients with solitary polyps, the diagnosis was accurate in 97.2% and diagnosis was correct in all patients with multiple polyps. Diagnostic errors were noted very often for small (up to 1 cm in diameter) polyps - at 2.9% on X-ray examination.
Thus, accurate diagnosis of benign adenomatous polyps was confirmed in 132 out of the 156 biopsies.
Conclusion. Nowadays, combined X-ray and gastroscopic examination is more widespread and affordable in the diagnosis of polyp in gastric stump. This method can be carried out as a dynamic observation of patients in this category. Combined X-ray and endoscopic examination of the stomach stump allows not only visually detection of abnormalities in early stage, but also an assessment of the mucosa state in the polyp area and away from it.