1. QUICK TIPS (--THIS SECTION DOES NOT PRINT--) This PowerPoint template requires basic PowerPoint (version 2007 or newer) skills. Below is a list of commonly asked questions specific to this template. If you are using an older version of PowerPoint, some template features may not work properly. Template FAQs Verifying the quality of your graphics Go to the VIEW menu and click on ZOOM to set your preferred magnification. This template is at 100% the size of the final poster. All text and graphics will be printed at 100% their size. To see what your poster will look like when printed, set the zoom to 100% and evaluate the quality of all your graphics before you submit your poster for printing. Modifying the layout This template has four different column layouts. Right-click your mouse on the background and click on LAYOUT to see the layout options. The columns in the provided layouts are fixed and cannot be moved but advanced users can modify any layout by going to VIEW and then SLIDE MASTER. Importing text and graphics from external sources TEXT: Paste or type your text into a pre-existing placeholder or drag in a new placeholder from the left side of the template. Move it anywhere as needed. PHOTOS: Drag in a picture placeholder, size it first, click in it and insert a photo from the menu. TABLES: You can copy and paste a table from an external document onto this poster template. To adjust the way the text fits within the cells of a table that has been pasted, right-click on the table, click FORMAT SHAPE then click on TEXT BOX and change the INTERNAL MARGIN values to 0.25. Modifying the color scheme To change the color scheme of this template go to the DESIGN menu and click on COLORS. You can choose from the provided color combinations or create your own. QUICK DESIGN GUIDE (--THIS SECTION DOES NOT PRINT--) This PowerPoint 2007 template produces a 30x40 inch professional poster. You can use it to create your research poster and save valuable time placing titles, subtitles, text, and graphics. We provide a series of online tutorials that will guide you through the poster design process and answer your poster production questions. To view our template tutorials, go online to PosterPresentations.com and click on HELP DESK. When you are ready to print your poster, go online to PosterPresentations.com. Need Assistance? Call us at 1.866.649.3004 Object Placeholders Using the placeholders To add text, click inside a placeholder on the poster and type or paste your text. To move a placeholder, click it once (to select it). Place your cursor on its frame, and your cursor will change to this symbol. Click once and drag it to a new location where you can resize it. Section Header placeholder Click and drag this preformatted section header placeholder to the poster area to add another section header. Use section headers to separate topics or concepts within your presentation. Text placeholder Click and drag this preformatted text placeholder to the poster to add a new body of text. Picture placeholder Click and drag this graphic placeholder onto your poster, size it first, and then click on it to add a picture to the poster. RESEARCH POSTER PRESENTATION DESIGN © 2012 www.PosterPresentations.com © 2013 PosterPresentations.com 2117 Fourth Street, Unit C Berkeley CA 94710 posterpresenter@gmail.com Student discounts are available on our Facebook page. Go to PosterPresentations.com and click on the FB icon. Numerous older studies have reported the association between Billroth II (BII) and Gastric Cancer / Gastric Stump Cancer (GCa) 20 -30 years post surgery. For example: in a meta-analysis of 28 articles published in 1990 (1) the Relative risk of GCa after 20- 30 years we estimated as 1.6. Of note in this study all BIIs were done for ULCER DISEASE (think H. Pylori.) The Mini-Gastric Bypass includes a BII gastro- jejunostomy and some critics of the operation have raised the risk of gastric cancer in these patients. The purpose of this study is to review the current knowledge on GCa, BII and the risk of GCa following BII in 2013. Introduction Methods Results -Some studies *Do* show slight Increased risk of GCa 20-30 years after B2 (RR 1.5), In these studies: B2 performed to Rx Ulcer; Ulcer Increases Risk GCa (H. Pylori) Ulcer and H. Pylori increase risk of GCa. Increased compared to population related H.Pylori/Ulcer -Magnitude Risk (Confusion between statistically significant and Clinically relevant) -In studies that *DO* increased risk RR mean = 1.5 -Comparison to 50 g of processed meat (=1 “Hot Dog”) eaten for 6 years increased risk RR mean = 2.5 -To Restate 6 yrs of “Hot Dog” diet more deadly than 30 yrs of BII. -Gastroenterologists Generally Ignore BII -Endoscopic screening of B2 patients is generally *Not* recommended; REASON because of Low Risk. Follow-up study of 1000 patients, 22-30 year follow-up 196 endoscopy and biopsy No Cancer of the gastric remnant seen, Endoscopic screening will be “unrewarding” -General, Trauma and Oncologic surgeons Routinely use the B2. In 2007 16,000 B2 procedures performed in USA. The B2 is still the most widely used reconstruction after distal gastric resection (Billroth II in use for over 100 years & over 1, 400 reported papers on Medline.) Conclusions Risk Gastric Cancer (GCa) after BII low/not clinically significant. GCa rates Declining Rapidly, GCa Preventable Rx H.Pylori, Avoid Etoh, Tobacco, Processed meat/food, encourage Fresh Fruit Veges. Many studies show no increased risk of GCa after BII, those that do may be related to H.Pylori infection of ulcer, Not BII. Risk is so low most GI Docs do not recommend routine screening for follow up (except China/Japan) General Trauma and Oncologic surgeons continue to use the BII routinely as part of their surgical practice. The recent and distant literature on the causes prevention and outcomes of GCa, BII, the use of BII and the relation between GCa and BII. Dr. Rutledge, Tel: +1-702 714 0011, E-mail: drr@clos.net Please Note: I have 18 presentations (14 oral and 4 posters) If I am not present please email or Call me and I will be right back. DrR RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS -GCa rates are declining rapidly around the world. The incidence of gastric cancer in the United States has Decreased four-fold since 1930, Approximately 7 cases per 100,000 people. GCa mostly affects elderly. Mean age of when diagnosed is 70. Two thirds 65 or older. -GCa Cause, primarily easily modified environmental factors; Diet, Lifestyle factors & H. Pylori; Prevention: Avoid Etoh, Smoking, Processed/Salted meats and foods; Encourage high intake of fruits & vegetables & Rx H. Pylori. -Many Large scale Studies document No Increased Risk in GCa after BII. Mayo Clinic Study; 338 Billroth II patients Followed 25-years, 5,635 person-years, Only 2 Cancers in 5,000+ pt years of Follow Up. Predicted 2.6 cancers (relative risk 0.8) AND Study Published 1983 = GCa Declined by 50% so 2013 risk GCa 1/5,000 yrs. Lower risk in BII patients! Results