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Earlier studies suggested that PA was restricted to Northern Europeans, but subsequent studies indicate that PA affects virtually all ethnic groups.37 Pernicious anaemia was considered a classical cause of vitamin B 12 deficiency before food-cobalamin malabsorption was described, and accounted for 15% to 25% of vitamin B 12 deficiency in the elderly in studies.9 In a local study on 296 Chinese patients, definite PA was diagnosed in 61% of patients having megaloblastic anaemia with vitamin B 12 or folate deficiency.38 Pernicious anaemia is characterised by destruction of gastric mucosa, especially fundal mucosa, primarily by a cell-mediated mechanism.39 There is progressive destruction and eventual loss of intrinsic factor producing gastric parietal cells

Since the introduction of the laparoscopic technique to PEH treatment by Cuschieri [14] in 1992, the minimally invasive approach has spread rapidly

These risks are theoretical, not documented in human trials, but they are reasons community references include cycle off-periods