Risk of development of gastric carcinoma in patients with pernicious anemia: a population-based study in Rochester, Minnesota.

To determine the long-term risk of the development of gastric cancer among patients with pernicious anemia, we identified the 152 residents of Rochester, Minnesota, who had well-documented pernicious anemia during the 30-year period 1950 through 1979. These patients were subsequently followed up for more than 1,550 person-years of observation. The observed risk of the development of a gastric cancer in this cohort was compared with that expected on the basis of incidence rates of gastric cancer for the local population. We found one case of gastric carcinoma among our 152 patients with pernicious anemia as compared with an expected incidence of 1.02 (relative risk, 1.0; 95% confidence interval, 0.02 through 5.5). We conclude that no strong indication exists for either radiographic or endoscopic surveillance in asymptomatic patients with pernicious anemia.

The Budd-Chiari syndrome. Medical and surgical management of 30 patients.

A retrospective review of 30 patients with documented Budd-Chiari syndrome disclosed an overall mortality of 57%. Medical treatment alone was associated with an 86% mortality; hepatic failure was the most common cause of death. Mortality was 31% overall for the surgical group, but there were long-term survivors among patients undergoing portacaval shunting. From this series, no single surgical procedure was found to be clearly superior. Surgical treatment with a side-to-side portacaval shunt seems to be the preferred operation when it can be performed. Surgical intervention should proceed soon after the diagnosis is made, lest extension of thrombus occur. Medical therapy most often is ineffective.

Indications, complications, and long-term results of percutaneous endoscopic gastrostomy: a retrospective study.

The purpose of this study was to determine the indications, success rate, procedure related complications, duration of tube feeding and long-term outcome in 35 consecutive patients in whom we attempted a percutaneous endoscopic gastrostomy (PEG). All procedures were performed in a small University affiliated VA Medical Center Between July 1988 and June 1991 by the same team. Follow-up continued until death or October 1992. The most common indications for PEG were neurologic disorders (n = 30, 90%). PEG was successfully placed in 32 (91%) of the 35 patients. There was no procedure related mortality. Complications occurred in 43% of patients, most of which were minor (97%). In seven patients (22%), tubes were removed as eating was resumed. Two patients died within 30 days of tube placement. Most of the deaths occurred between one and six months (40%) after tube placement. Pneumonia was the most common cause of death and was attributed to aspiration of oropharyngeal secretions. Our experience suggests that PEG is safe and has a low complication rate, even in patients with multiple medical problems.

The risk of gastric carcinoma after surgical treatment for benign ulcer disease. A population-based study in Olmsted County, Minnesota.

To determine the long-term risk of gastric cancer in benign peptic-ulcer disease, we studied 338 residents of Olmsted County, Minnesota, who had surgical treatment for benign peptic-ulcer disease in the 25-year period 1935-1959 and had no evidence of gastric cancer for five years after that surgery. These patients were subsequently followed for over 5635 person-years of observation. The risk of development of a gastric cancer in this group was compared with that expected on the basis of gastric-cancer incidence rates for the local population. Carcinomas in the gastric remnant developed in only two of these patients, as compared with an expected 2.6 primary gastric carcinomas (relative risk, 0.8 [95 per cent confidence interval, 0.1 to 2.7]). We conclude that there is no indication for endoscopic surveillance in asymptomatic patients with previous gastric surgery for benign peptic-ulcer disease.