Irrational Fear of Gastric Cancer:
CHOOSING THE BEST WEIGHT LOSS
SURGERY
R Rutledge MD,
www.CLOS.net
Email: DrR@clos.net
Irrational Fears of Cancer
General Surgeons Use the Billroth II
Bariatric Surgeons FEAR the Billroth II
(Mini-Bypass)
At W...
Dr Rutledge: Training &
Background
• Undergrad/Medical School; Teacher
Dr. Lester Dragstedt Pioneer / Inventor of the
High...
Dr Rutledge: Training &
Background
• Specialty: Trauma, Critical Care, Medical Informatics
and Bariatric Surgery (1978-199...
Dr. Rutledge
USA 001-702-714-0011 DrR@clos.net
CONSIDERING THE MGB?
MGB IS A SUPERB SURGERY
BUT…
WARNING:
“THERE ARE “TRIC...
OFFER A SAFE & SUCCESSFUL
MGB PROGRAM
• Call / Email: Anytime question or advice on any clinical,
technical or patient MGB...
MGB Results
• In Short
• By every measure
• In every study
• By Every Author
• MGB Equal to or Better Than
any other form ...
Fear of Mini-Bypass
• Numerous studies now confirm
that the Mini-Gastric Bypass (MGB)
is
• Short, simple, highly effective...
Lack of Knowledge and Patient
Outcomes
• Studies Show Correlation Between
Surgeon's knowledge in there areas of
expertise ...
Fear of Gastric Caner after Mini-Bypass
Purpose: Education
1 Gastric Cancer (GCa)
2 Declining Risk
3 Causes Prevention GCa...
Human Decision Making
• Numerous Studies show that
Human Decision Making is far from
the ideal logical and rational skill
...
Survey 102 Bariatric Surgeons
• Experience with over 39,000 cases
• Surgeons who
Fear of GCa after MGB
• Significantly LES...
Begin with Education
Gastric Cancer (GCa)
• Studies Show just the Word
"Cancer" engenders an inordinate
amount of fear in study
participants
• ...
Gastric Cancer (GCa)
Declining Risk
• There has been a long-term decline
in incidence of stomach cancer in
virtually all c...
Gastric cancer is declining in
Japan and all over the world
• The incidence of gastric cancer is declining
in Japan and al...
Gastric Cancer (GCa)
Declining Risk
• Researchers at Harvard School of
Public Health CGA declined 60%
between 1978 and 200...
Gastric Cancer (GCa)
Declining Risk
• What to KNOW
1. Worldwide Massive Decline of GCa
2. Why?
= Decline in Smoking
= Refr...
Causes/Prevention GCa
• H. pylori can cause peptic ulcers.
cause of stomach cancer
• Smoking: Heavy smokers are most at
ri...
Fear Gastric Cancer?
Prevention is Simple!
• Rx H Pylori
• STOP Smoking
• Diet: DO NOT EAT Smoked, Salted,
Or Pickled food...
H Pylori GCa
• H. pylori infection is the major
cause of gastric (stomach) cancer
• "Helicobacter pylori causes gastric
ca...
Fear Gastric Cancer?
•Rx H Pylori
• STOP Smoking
• Diet: DO NOT EAT Smoked, Salted,
Or Pickled foods
• * DO Eat * fresh fr...
Billroth II and GCa
Many Surgeons who fear the
GCa Association with MGB not
clear on the research on this
topic
Billroth II and GCa
Studies showing NO Increased Risk of GCa
Post BII
• Many Surgeons who fear the GCa
Association with MG...
BARIATRIC SURGEONS FEAR BILLROTH II
Many Studies Show NO Association
• Mayo Clinic Study (Example)
• 338 Billroth II patie...
BARIATRIC SURGEONS FEAR BILLROTH II
MAGNITUDE OF THE PROBLEM
• Population based study, 338 Billroth II
pts
• Followed 25-y...
BARIATRIC SURGEONS FEAR BILLROTH II
No Association of Billroth II and Gastric Ca
• 338 Billroth II pts, Followed 25-yrs
• ...
BARIATRIC SURGEONS FEAR BILLROTH II
No Association of Billroth II and Gastric Ca
• Only 2 Cancers in 5,000 pt yrs follow u...
BARIATRIC SURGEONS FEAR BILLROTH II
No Association of Billroth II and Gastric Ca
• Remember!
• RATE of Gastric Cancer is D...
Billroth II and GCa
• Many Surgeons who fear the GCa
Association with MGB do not know that
• Many Studies of BII and GCa S...
Remember
If You Fear Gastric Cancer?
• Rx H Pylori
• STOP Smoking
• Diet: DO NOT EAT Smoked, Salted,
Or Pickled foods
• * ...
Some Studies DO show
Increased Risk of GCa after
BII...BUT in these studies
BII Done for ULCERS!
Meta-analysis:
7 studies ...
Some Studies DO Show
Association Billroth II and GCa
• Ulcers associated with increased
risk of GCa
• Why?
• Because H.Pyl...
Some Studies DO Show
Association Billroth II and GCa
• Meta-analysis:
7 studies show Small increased risk
5 studies No Inc...
Reminder:
Ulcers and GCa
Both
CAUSED by H Pylori!
Some Studies DO Show
Association Billroth II and GCa
• 7 studies show Small increased risk
BUT...
• Studies increased Risk...
Some Studies DO Show
Association Billroth II and GCa
• Increased Risk of BII vs
Population; Flawed
• Billroth II performed...
BII and GCa
• Many Studies Show No Association
between BII and GCa
• Some studies DO show an association
• But
• In the st...
General Surgeons Routine Use of BII
Bariatric Surgeons Fear Billroth II;
General Surgeons Choose Billroth II
Trauma Surgeo...
BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
• 1,490 articles on performance of the Billroth
II...
BARIATRIC SURGEONS FEAR BILLROTH II;
CANCER SURGEONS CHOOSE BILLROTH II
• Studies from Oncologic Surgeons
from Korea and C...
Incidence/Frequency of
GCa
Do you fear being struck by
Lighting?
Do you fear Gastric Cancer after
Billroth II?
Incidence/Frequency of
GCa
• From Cancer.org
• USA Lifetime Risk of stomach
Cancer * 0.5% *
• MD India * 0.51% *
• Declini...
Cancer from CAT Scans
Additional Cancer Risk(%)
Abd/Pelvis CT
Additional Cancer Risk(%) ++0.14%
2 Abd/Pel CtScan + Contras...
Lifetime Risk of Gastric Cancer &
Predicted Increased Risk from
WORST Billroth II Studies (RR1.5)
Baseline Lifetime Risk o...
Lifetime Risk of Gastric Cancer &
Predicted Increased Risk from
WORST Billroth II Studies (RR1.5)
Baseline Lifetime Risk o...
Declining Rates of Stomach
Cancer
• Stomach cancer incidence rates have
decreased since the mid-1970s
• For males, Europea...
Comparison of Risk of Worst
Predicted Outcomes of BII
Compared to 1 or 2 CT Scans
• 1 or 2 CT Scans vs BII
(as predicted b...
Fear CTScans?
• Many studies show no increased
risk of GCa after BII
• Of the old studies that do show an
increased risk t...
Fear the Hot Dog?
Fear the Hot Dog?
• 100 g increment the
association between
processed meat
increased risk of
gastric cancer
(** RR 5.0 **)...
CANCER QUIZ: MORE DEADLY
CANCER CAUSING AGENT? A
OR B
AA BB
• Answer Hot Dog
• Do you Fear Hot
Dog or a CAT
Scan?
• Remember Many
Studies of Billroth II
Show No increased
Risk of GCa...
UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 1. Gastric Cancer Declining Rapidly, > 50%
• 2. Gastric Cancer Caus...
UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 3. Some studies Slight Increased Risk of
gastric cancer after 20 – ...
UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 5. Endoscopic screening of Billroth II patients
is Not Recommended....
UNINFORMED FEAR BILLROTH II
EDUCATED USE BILLROTH II
• 8. Billroth II and the Mini-Gastric Bypass
Excellent, Safe and Effe...
• Rational Review of the Data vs.
Fear Gastric Cancer / Bile Reflux
• Rational Thinking vs. Reptilian
Brain
Rational Data Analysis vs.
Irrational FEAR Gastric Cancer
• 1. Gastric Cancer Declining Rapidly
• 2. GC Environmental Caus...
FEAR OF GASTRIC CANCER
• FEAR gastric cancer?
• Avoid: Alcohol, Tobacco, Processed
& Preserved Meats
Rx: H. Pylori,
Eat Fr...
FEAR OF GASTRIC CANCER
A Billroth II
Probably Makes No
Difference
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Fear of Cancer , General Surgeons Use the Billroth II , Bariatric Surgeons FEAR the Billroth II

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Irrational Fears of Cancer General Surgeons Use the Billroth II Bariatric Surgeons FEAR the Billroth II (Mini-Bypass)

Irrational Fear of Gastric Cancer: CHOOSING THE BEST WEIGHT LOSS SURGERY, R Rutledge MD, www.CLOS.net, Email: DrR@clos.net. http://www.slideshare.net/DrRRMD/fear-g-ca-02-0214v2

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Fear of Cancer , General Surgeons Use the Billroth II , Bariatric Surgeons FEAR the Billroth II

  1. 1. Irrational Fear of Gastric Cancer: CHOOSING THE BEST WEIGHT LOSS SURGERY R Rutledge MD, www.CLOS.net Email: DrR@clos.net
  2. 2. Irrational Fears of Cancer General Surgeons Use the Billroth II Bariatric Surgeons FEAR the Billroth II (Mini-Bypass) At WORST Lifetime Risk Billroth II is Less Risky than 2 CATScans or Eating a Hot Dog! Surgeons with Greatest Fear => Least Well Informed
  3. 3. Dr Rutledge: Training & Background • Undergrad/Medical School; Teacher Dr. Lester Dragstedt Pioneer / Inventor of the Highly Controversial Vagotomy and Pyloroplasty • 2 Years Cardiac Surgery National Institutes of Health National Heart Lung Blood Institute • 20 years University of NC; Professor of Surgery, Associate Chief of Staff, Director of Section Medical Informatics, Director North Carolina Trauma Registry • Author of 100 papers and articles
  4. 4. Dr Rutledge: Training & Background • Specialty: Trauma, Critical Care, Medical Informatics and Bariatric Surgery (1978-1998 20 years University NC) • Experience: Trauma Surgery, Director NC Trauma Registry • Peptic Ulcer Surgery; Vagotomy & Pyloroplasty; Antrectomy & Billroth II • Bariatric Surgery 33 years: Open RNY & Vertical Banded Gastroplasty • 1997 one first surgeons laparoscopic RNY • Mini-Gastric Bypass; 14 years, over 6,000 cases
  5. 5. Dr. Rutledge USA 001-702-714-0011 DrR@clos.net CONSIDERING THE MGB? MGB IS A SUPERB SURGERY BUT… WARNING: “THERE ARE “TRICKS AND TRAPS”
  6. 6. OFFER A SAFE & SUCCESSFUL MGB PROGRAM • Call / Email: Anytime question or advice on any clinical, technical or patient MGB question • USA 001-702-714-0011 DrR@clos.net • Personal Visit: Dr. Rutledge Visiting Professor: France, Turkey, Austria & India, Upcoming visits Greece, Istanbul, United Kingdom, Czech Republic, Italy, Germany • Please Use the Knowledge of Others Before You Start; Experience; over 14 years, over 6,000 patients • USA 001-702-714-0011 DrR@clos.net
  7. 7. MGB Results • In Short • By every measure • In every study • By Every Author • MGB Equal to or Better Than any other form of Bariatric Surgery
  8. 8. Fear of Mini-Bypass • Numerous studies now confirm that the Mini-Gastric Bypass (MGB) is • Short, simple, highly effective, very safe, very durable and easily revised surgery • In almost every way the MGB out performs the Sleeve, Band and RNY
  9. 9. Lack of Knowledge and Patient Outcomes • Studies Show Correlation Between Surgeon's knowledge in there areas of expertise and patient outcomes • Survey Data Showed : • Surgeons who FEAR GCa after MGB were much less knowledgeable about GCa and Billroth II and General Surgery than other Bariatric Surgeons
  10. 10. Fear of Gastric Caner after Mini-Bypass Purpose: Education 1 Gastric Cancer (GCa) 2 Declining Risk 3 Causes Prevention GCa 4 H Pylori GCa 5 Billroth II and GCa 6 General Surgeons Routine Use of BII 7 Incidence/Frequency of GCa 8 Studies showing NO Increased Risk of GCa Post BII 9 Some Studies DO show Increased Risk of GCa after BII...BUT in these studies BII Done for ULCERS! 10 Reminder Ulcers and GCa CAUSED by H Pylori! 11 Gastroenterologists DO NOT recommend endo F/U for BII patients; Why? BECAUSE THE RISK IS TOO LOW 12 Irrational Fears: Hot Dogs, CAT-Scans and Cognitive Biases in Humans and Bariatric Surgeons
  11. 11. Human Decision Making • Numerous Studies show that Human Decision Making is far from the ideal logical and rational skill that many of us imagine • Cognitive Biases • Foundation of Good Decision Making is a Clear understanding of the data
  12. 12. Survey 102 Bariatric Surgeons • Experience with over 39,000 cases • Surgeons who Fear of GCa after MGB • Significantly LESS Knowledgeable about GCa, General Surgery, outcomes of BII and MGB
  13. 13. Begin with Education
  14. 14. Gastric Cancer (GCa) • Studies Show just the Word "Cancer" engenders an inordinate amount of fear in study participants • Example what's more deadly cancer or bowel obstruction • To judge the right response to a risk we need to look at the actual data...
  15. 15. Gastric Cancer (GCa) Declining Risk • There has been a long-term decline in incidence of stomach cancer in virtually all countries worldwide • This is linked to falling rates of infection with H. pylori, and the use of refrigeration instead of salting to preserve foods,
  16. 16. Gastric cancer is declining in Japan and all over the world • The incidence of gastric cancer is declining in Japan and all over the world. • In a study conducted in Osaka prefecture, • the age-adjusted mortality rate for gastric cancer decreased from 84 (1963–65) to 41 (1987–89) for males and from • 41 to 18 for females during the same period
  17. 17. Gastric Cancer (GCa) Declining Risk • Researchers at Harvard School of Public Health CGA declined 60% between 1978 and 2008 • H. pylori infection and smoking accounted for 47% • Predicted 2008-2040, U.S. CGA rates will fall an additional 47%, and • H. pylori and smoking will contribute to more than 80% of the decline.
  18. 18. Gastric Cancer (GCa) Declining Risk • What to KNOW 1. Worldwide Massive Decline of GCa 2. Why? = Decline in Smoking = Refrigeration => Decrease in Nitrate in Preserved Foods/More Fresh Fruit and Veges AND = Decline in H.Pylori 3. NOT Billroth II
  19. 19. Causes/Prevention GCa • H. pylori can cause peptic ulcers. cause of stomach cancer • Smoking: Heavy smokers are most at risk. • Diet: Smoked, Salted, Or Pickled increased risk • Diet high in fresh fruits & vegetables lower risk • Sedentary and Obesity Increase Risk
  20. 20. Fear Gastric Cancer? Prevention is Simple! • Rx H Pylori • STOP Smoking • Diet: DO NOT EAT Smoked, Salted, Or Pickled foods • * DO Eat * fresh fruits & vegetables • Be Active and Rx Obesity
  21. 21. H Pylori GCa • H. pylori infection is the major cause of gastric (stomach) cancer • "Helicobacter pylori causes gastric cancer in human and in experimental animals. " • Many surgeons who fear GCa in MGB did not seem to be clear on this simple fact
  22. 22. Fear Gastric Cancer? •Rx H Pylori • STOP Smoking • Diet: DO NOT EAT Smoked, Salted, Or Pickled foods • * DO Eat * fresh fruits & vegetables • Be Active and Rx Obesity
  23. 23. Billroth II and GCa Many Surgeons who fear the GCa Association with MGB not clear on the research on this topic
  24. 24. Billroth II and GCa Studies showing NO Increased Risk of GCa Post BII • Many Surgeons who fear the GCa Association with MGB do not know that • Many Studies of BII and GCa Show • NO ASSOCIATION • Studies showing NO Increased Risk of GCa Post BII
  25. 25. BARIATRIC SURGEONS FEAR BILLROTH II Many Studies Show NO Association • Mayo Clinic Study (Example) • 338 Billroth II patients • Followed 25-years • 5,635 person-years • Only 2 Cancers in 5,000+ pt years of Follow Up • Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309
  26. 26. BARIATRIC SURGEONS FEAR BILLROTH II MAGNITUDE OF THE PROBLEM • Population based study, 338 Billroth II pts • Followed 25-years • 5,635 person-years • Only 2 Cancers Found in 5,000 years • Predicted 2.6 cancers (relative risk 0.8) Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309
  27. 27. BARIATRIC SURGEONS FEAR BILLROTH II No Association of Billroth II and Gastric Ca • 338 Billroth II pts, Followed 25-yrs • 5,635 person-years • Only 2 Cancers in 5,000 pt yrs follow up • Lifetime Risk GCa after BII 0.04% • RATE of Gastric Cancer is Declining • 24 - 50% Expected Decrease from 1983 • Future risk <<1 patient / 5,000 pt years
  28. 28. BARIATRIC SURGEONS FEAR BILLROTH II No Association of Billroth II and Gastric Ca • Only 2 Cancers in 5,000 pt yrs follow up • Lifetime Risk GCa after BII 0.04% • Remember! • RATE of Gastric Cancer is Declining • This was Published in 1983! • 24 - 50% Expected Decrease from 1983 • Future risk GCa: ~1 pt / 5,000 pt yrs • Lifetime Risk of GCa after 5,000 pt yrs FU 0.02% Less than the risk for the rest of the population!
  29. 29. BARIATRIC SURGEONS FEAR BILLROTH II No Association of Billroth II and Gastric Ca • Remember! • RATE of Gastric Cancer is Declining • This was Published in 1983! • 24 - 50% Expected Decrease from 1983 • Future risk GCa: ~1 pt / 5,000 pt yrs • Lifetime Risk of GCa after 5,000 pt yrs FU 0.02% • Less than the risk for the rest of the population!
  30. 30. Billroth II and GCa • Many Surgeons who fear the GCa Association with MGB do not know that • Many Studies of BII and GCa Show • NO ASSOCIATION
  31. 31. Remember If You Fear Gastric Cancer? • Rx H Pylori • STOP Smoking • Diet: DO NOT EAT Smoked, Salted, Or Pickled foods • * DO Eat * fresh fruits & vegetables • Be Active and Rx Obesity
  32. 32. Some Studies DO show Increased Risk of GCa after BII...BUT in these studies BII Done for ULCERS! Meta-analysis: 7 studies show Small increased risk 5 studies No Increased Risk
  33. 33. Some Studies DO Show Association Billroth II and GCa • Ulcers associated with increased risk of GCa • Why? • Because H.Pylori Infection • AND • H. Pylori causes GCa (RR = 1.53)
  34. 34. Some Studies DO Show Association Billroth II and GCa • Meta-analysis: 7 studies show Small increased risk 5 studies No Increased Risk • Some Studies DO Show Association Billroth II and GCa • (RR = 1.5) similar to ulcers • BUT...
  35. 35. Reminder: Ulcers and GCa Both CAUSED by H Pylori!
  36. 36. Some Studies DO Show Association Billroth II and GCa • 7 studies show Small increased risk BUT... • Studies increased Risk; Flawed • Why Billroth II? Rx Ulcers • Ulcers = H. Pylori Infection • H. Pylori Infection => GCa
  37. 37. Some Studies DO Show Association Billroth II and GCa • Increased Risk of BII vs Population; Flawed • Billroth II performed to Rx Ulcers • Ulcers = H. Pylori Infection • H. Pylori Infection => GCa • Increased GCa from H Pylori NOT BII
  38. 38. BII and GCa • Many Studies Show No Association between BII and GCa • Some studies DO show an association • But • In the studies that do show an association the BII was done for Ulcers • Ulcers = H. Pylori • H. Pylori causes GCa • Billroth II probably has little or nothing to do with RR of GCa
  39. 39. General Surgeons Routine Use of BII Bariatric Surgeons Fear Billroth II; General Surgeons Choose Billroth II Trauma Surgeons Choose Billroth II Oncologic Surgeons Choose Billroth II
  40. 40. BARIATRIC SURGEONS FEAR BILLROTH II; CANCER SURGEONS CHOOSE BILLROTH II • 1,490 articles on performance of the Billroth II • General/Trauma/Oncologic surgeons commonly use the Billroth II • Over 16,000 Billroth II operation performed in USA 2007 • While Bariatric Surgeons Fear the Billroth II General Surgeons use the Billroth II routinely
  41. 41. BARIATRIC SURGEONS FEAR BILLROTH II; CANCER SURGEONS CHOOSE BILLROTH II • Studies from Oncologic Surgeons from Korea and China • Location of some of the highest rates of GCa in the world • Routinely report the use of Billroth II reconstructions in GCa patients
  42. 42. Incidence/Frequency of GCa Do you fear being struck by Lighting? Do you fear Gastric Cancer after Billroth II?
  43. 43. Incidence/Frequency of GCa • From Cancer.org • USA Lifetime Risk of stomach Cancer * 0.5% * • MD India * 0.51% * • Declining Rates of Stomach Cancer
  44. 44. Cancer from CAT Scans Additional Cancer Risk(%) Abd/Pelvis CT Additional Cancer Risk(%) ++0.14% 2 Abd/Pel CtScan + Contrast 40mSv Additional Cancer Risk(%) ++0.28%
  45. 45. Lifetime Risk of Gastric Cancer & Predicted Increased Risk from WORST Billroth II Studies (RR1.5) Baseline Lifetime Risk of GCa 0.50% Using Worst Billroth II studies Predicted Additional Cancer Risk(%) ++0.25%
  46. 46. Lifetime Risk of Gastric Cancer & Predicted Increased Risk from WORST Billroth II Studies (RR1.5) Baseline Lifetime Risk of GCa 0.50% Using Worst Billroth II studies Predicted Additional Cancer Risk(%) ++0.25%
  47. 47. Declining Rates of Stomach Cancer • Stomach cancer incidence rates have decreased since the mid-1970s • For males, European AS incidence rates decreased by *59%* between 1975-1977 and 2008-2010. • The decline is slightly bigger for women, with rates decreasing by *64%* between 1975-1977 and 2008- 2010.
  48. 48. Comparison of Risk of Worst Predicted Outcomes of BII Compared to 1 or 2 CT Scans • 1 or 2 CT Scans vs BII (as predicted by the worst BII risk studies, published in the 60's-80's) • CT Scan 0.78% vs BII 0.75% • Lifetime risk cancer
  49. 49. Fear CTScans? • Many studies show no increased risk of GCa after BII • Of the old studies that do show an increased risk the magnitude of the risk is about the risk see with one or two CT Scans • Fear CT Scans?
  50. 50. Fear the Hot Dog?
  51. 51. Fear the Hot Dog? • 100 g increment the association between processed meat increased risk of gastric cancer (** RR 5.0 **) • One Hot Dog = 100g
  52. 52. CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B AA BB
  53. 53. • Answer Hot Dog • Do you Fear Hot Dog or a CAT Scan? • Remember Many Studies of Billroth II Show No increased Risk of GCa CANCER QUIZ: MORE DEADLY Hot Dog or Mini-Gastric Bypass AA
  54. 54. UNINFORMED FEAR BILLROTH II EDUCATED USE BILLROTH II • 1. Gastric Cancer Declining Rapidly, > 50% • 2. Gastric Cancer Cause: Environmental Factors / Easily Prevented Diet, Lifestyle changes and Rx of H. Pylori (Avoid Etoh, smoking, processed & salted meats and foods, seek high intake of fruits and vegetables)
  55. 55. UNINFORMED FEAR BILLROTH II EDUCATED USE BILLROTH II • 3. Some studies Slight Increased Risk of gastric cancer after 20 – 30 years (RR 1.5): But: BII to Rx Ulcer => Ulcer => Increased Risk • (Worried? Rx H Pylori, Eat healthy etc.) • 4. Many Large Studies: No Increased Risk Thousands of patients followed for Decades
  56. 56. UNINFORMED FEAR BILLROTH II EDUCATED USE BILLROTH II • 5. Endoscopic screening of Billroth II patients is Not Recommended. Why? Low Risk! • 6. General, Trauma and Oncologic surgeons routinely use the Billroth II (Thousands of publications) • 7. 2007 ~16,000 BII procedures were performed in the USA
  57. 57. UNINFORMED FEAR BILLROTH II EDUCATED USE BILLROTH II • 8. Billroth II and the Mini-Gastric Bypass Excellent, Safe and Effective • 9. FEAR Gastric Cancer? Avoid ETOH, Tobacco, Processed & Preserved Meats, Rx H. Pylori, Eat Fruits and Veggies, Yogurt and Drink Green Tea • A Billroth II probably makes NO difference
  58. 58. • Rational Review of the Data vs. Fear Gastric Cancer / Bile Reflux • Rational Thinking vs. Reptilian Brain
  59. 59. Rational Data Analysis vs. Irrational FEAR Gastric Cancer • 1. Gastric Cancer Declining Rapidly • 2. GC Environmental Causes; Easily Prevented • 3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori • 4. Many large studies: NO increased risk • 5. Endoscopic Screening: Not Recommended • 6. General, Trauma & Oncologic Surgeons Use Billroth II
  60. 60. FEAR OF GASTRIC CANCER • FEAR gastric cancer? • Avoid: Alcohol, Tobacco, Processed & Preserved Meats Rx: H. Pylori, Eat Fruits & Veggies, Yogurt • Billroth II Probably Makes NOBillroth II Probably Makes NO DifferenceDifference
  61. 61. FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference
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