An endoscopic study of ulcer recurrence and mucosal changes following vagotomy and excision of gastric ulcer.

Follow-up of patients operated on for gastric ulcer--137 with selective gastric vagotomy (SGV), pyloroplasty and ulcer excision (1967-1976) and 72 with proximal gastric vagotomy (PGV) and ulcer excision (1974-1984)--was supplemented with data from recent clinical, endoscopic and biopsy studies in 78 of the patients. Ulcer recurred in 27/137 SGV and 7/72 PGV cases (20.3 and 9.9%). Four patients died of gastric cancer 5-7 years after SGV. Of the endoscopically reexamined patients, 1/42 with SGV and 1/36 with PGV were found to have asymptomatic ulcer. The incidence of gastric stasis with food retention was 35.7% in the SGV, and 8.3% in the PGV group, and the respective incidences of severe gastric mucosal inflammation with fibrinous deposits were 42.9% and 2.7%. Mild or moderate dysplasia was shown in biopsies from 16.6% of the SGV and 8.3% of the PGV group. The high dysplasia incidence, especially after SGV, and the four gastric cancer deaths in that group indicate a need for long-term follow-up evaluation of possibly increased gastric cancer risk following vagotomy.