Gastroenterology: To Freeze or Not to Freeze?

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Controversy over both the value and safety of stomach freezing as a treatment of duodenal ulcers has been growing ever since a research team working under Surgery Professor Owen H. Wangensteen at the University of Minnesota Hospitals reported the first promising results (TIME, May 18, 1962). Freezing the stomach wall for a short time, Dr. Wangensteen explained, knocks out much of its capacity for producing hydrochloric acid, thus reducing the amount of the corrosive juice that flows into the duodenum, the next chamber down the digestive tract. If acid production should bounce back, he said, the stomach could safely be refrozen. (Whether the technique should be used for gastric ulcers, in the stomach itself, is a separate, unresolved question.)

Bland Tradition. Now Professor Claude R. Hitchcock, a member of Dr. Wangensteen's own surgery faculty, reports that the Wangensteen treatment is not much good. At best, says Dr. Hitchcock in the Journal of the A.M.A., it is no better than traditional medical management of duodenal ulcers—meaning antacid pills and a bland diet.

Sticking close to the original Wangensteen cooling method of pumping alcohol, at a temperature near zero Fahrenheit, into a stomach balloon, Dr. Hitchcock and his team treated 173 patients, 172 of whom have now been followed for 18 months (one was killed in an auto accident). They report that 50 have minimal ulcer pain remaining, and 13 have none—a satisfactory result rate of only 37%. No fewer than 71 of the patients still suffer pain, 37 more eventually had to have part of their stomachs removed, and one died from a gastric-ulcer perforation.

Spare the Knife. Dr. Wangensteen's faith in his technique remains unshaken. In a group of 701 of his patients, many of whom had repeat freezing, there was not one death. There have been some serious complications, including two perforating gastric ulcers. But of 71 recent patients, most of them followed for 18 months, only five have needed surgery, while 26 others still have intermittent ulcer pain. The satisfactory result rate is 51 % . One reason for the difference between his record and Hitchcock's, said Dr. Wangensteen, is that his team now uses liquid that is supercooled to — 40°F. when it enters the tube on its way to the stomach. This chills the stomach wall itself for six or seven minutes to 13°F.—far below freezing. Then the stomach is quickly rewarmed.

Whether all the variations in results can be traced to variations in procedure is a question the doctors are not yet ready to answer. Whatever the explanation, Dr. Wangensteen is sure that his technique is worth further study, for it saves a substantial number of patients from having part of their stomachs cut out.