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Lésions muqueuses gastriques après gastrectomie selon Billroth I pour ulcère gastrique bénin

Gastric mucosal lesions after Billroth I resection for benign gastric ulcer

  • Published:
Acta Endoscopica

Résumé

Le but de ce travail est de vérifier si la gastrectomie selon Billroth I (BI) est susceptible de protéger la muqueuse du moignon gastrique contre le développement d'une gastrite atrophique, de métaplasie intestinale et de dysplasie, lésions susceptibles d'évoluer vers le cancer.

L'étude porte sur 84 patients soumis à une gastrectomie de type BI pour ulcère gastrique bénin. Le classement clinique a été réalisé selon les critères de Visick, et les malades soumis à une endoscopie avec biopsies muqueuses multiples. La répartition des patients selon les catégories est la suivante: Visick I: 50 patients (59,5%), Visick II: 29 patients (34,5%), et Visick III: 5 patients (6%). 30% des patients examinés présentaient des lésions histologiques significatives: gastrite atrophique: 9 patients (10,7%), métaplasie intestinale: 13 patients (15,5%), dysplasie modérée: 4 patients (4,8%).

Les lésions histologiques prédominent dans la région périanastomotique.

Les auteurs soulignent l'importance de la biopsie en cours de gastroscopie du fait de l'absence de relation entre gravité des lésions muqueuses, critères de Visick, aspects macroscopique et endoscopique et délai par rapport à l'intervention.

Le délai minimum d'apparition de lésions muqueuses significatives au niveau du moignon gastrique après gastrectomie Billroth I semble de l'ordre de 12 mois.

Summary

The aim of this study is to determine whether Billroth I procedure may protect gastric stump mucosa from the appearance of atrophic gastritis, intestinal metaplasia and dysplasia that may lead to cancer.

Eighty-four patients who had undergone a Billroth I resection for benign gastric ulcer, were clinically evaluated in accordance to Visick criteria and examined by endoscopy and multiple mucosal biopsies; 50 (59.5%) of them were included in the Visick I class, 29 (34.5%) in the II one, 5 (6%) in the III one.

Serious histological lesions occured in 30% of the patients of this study. Atrophic gastritis was found in 9 patients (10.7%), intestinal metaplasia in 13 (15.5%), mild dysplasia in 4 (4.8%). These lesions were observed more frequently in the peri-anastomotic area. The importance of histological examination has been emphasized since no precise correlation seemed justified between severity of mucosal changes on one hand, and the Visick criteria, endoscopic appearance, and time interval after operation on the other hand.

It appeared that 12 months are the minimum time required to develop serious mucosal lesions following BI surgical procedure.

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Authors and Affiliations

  1. Department of Surgery, General Hospital Chiari-Rovato, Chiari

    E. Pelizzari

  2. Department of Surgery, General Hospital Chiari-Rovato, Chiari

    M. Guindani

  3. Department of Pathology, General Hospital Chiari-Rovato, Chiari

    F. Cerqui

  4. Department of Pathology, General Hospital Chiari-Rovato, Chiari

    R. Airo

Authors
  1. E. Pelizzari
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  2. M. Guindani
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  3. F. Cerqui
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  4. R. Airo
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Pelizzari, E., Guindani, M., Cerqui, F. et al. Lésions muqueuses gastriques après gastrectomie selon Billroth I pour ulcère gastrique bénin. Acta Endosc 13, 309–318 (1983). https://doi.org/10.1007/BF02973424

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  • DOI: https://doi.org/10.1007/BF02973424

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