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GU Johnson classification Type1--angularis incisura Txdistal gastrectomy Type2--1+DU TxTV+A, HSV(2nd ) Type3prepyloric Tx-->TV+A, HSV (2nd) Type4--hi lesser curve/near EGJ Txdistal gastrectomy, TV+P or HSV (2nd) Type5--Nsaid induceanywhere Txstop Nsaid (Type 2/3--acid hypersecretion) Nsaid Who need PPI -60yr -Hx of acid/peptic dz -concurrent steroid intake -concurrent anticoag intake -hi-dose Nsaid/ASA EGD ->45 yr + new onset dyspepsia -Alarm symp :wt loss, dysphagia, bleeding, anemia, -hi risk pt :HNPCC, FAP, menetrier, s/p gastrectomy
4.Intractable,nonhealing DDx Ca--gastric,pancreatic,duodenum Persistent H.pylori--false-ve Non-compliance ZES DU 1.HSV 2.V+D 3.V+A GU HSV,wedge distal gastrec
-EBV -menetrier dz
Decrease risk -aspirin -vegetable/fruit diet -vit c,e Genetic factor -p53 and COX-2 gene :deletion or suppression of p53 :overexpression of COX-2
Extent of lymphadenectomy -D1:station 3-6 D2:station 1,2,7,8,11 D3:station 9,10,12 USA :D1 resection Asia :D2 gastrectomy :resect peritoneal over panc, ant mesocolon :hi M&M CMT,RTX -adjuvant tx c CMT (5FU,LV) and RTX benefit in resected pt c stage II,III -no indication for RTX alone :can be effective in bleeding or pain Screening -FAP,adenoma,intes meta/dysplasia HNPCC,Menetrier ds,remote gastrec