Gastric intestinal metaplasia eleven years after randomized selective proximal vagotomy for peptic ulcer.

The presence of intestinal metaplasia (IM) 11 years after selective proximal vagotomy (SPV), selective proximal vagotomy with pyloroplasty (SPV + PP) and selective vagotomy with pyloroplasty (SV + PP) was investigated in 38 consecutive patients. IM was significantly more frequent in SPV than in SV + PP, SPV + PP or in unoperated controls of matching ages. IM occurred more frequently both at an older age (> or = 60 years) in SPV and in a larger number of gastric areas than in the other group of patients. Reports in the literature indicate that vagotomy may increase the risk of gastric carcinoma and that IM may antedate malignant transformation. It would thus appear that patients previously operated with SPV (without pyloroplasty) having IM, should be the group of patients to be enrolled in endoscopical surveillance programs for detection of possible cancer development.