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Letter
Pathology and cost effectiveness of endoscopy surveillance for premalignant gastric lesions
  1. M Rugge1,
  2. M Cassaro1,
  3. G Pennelli1,
  4. V M Russo1,
  5. F Di Mario2,
  6. F Farinati3
  1. 1Dipartimento di Scienze Oncologiche e Chirurgiche, Università degli Studi di Padova, Italy
  2. 2Cattedra di Gastreoenterologia, Università di Parma, Italy
  3. 3Dipartimento di Scienze Chirurgiche and Gastreoenterologiche, Università degli Studi di Padova, Italy
  1. Correspondence to:
    Massimo Rugge;
    massimo.rugge{at}unipd.it

https://doi.org/10.1136/gut.52.3.453

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    We read with great interest the article by Whiting et al (

    ). The Birmingham experience shows how the prevalence of gastric cancers detected at an early stage is significantly higher in the endoscopically surveyed population than in non-surveyed patients. As a result, this study demonstrates that, in the secondary prevention of gastric malignancy, the “once in a lifetime” strategy (suggested for colorectal cancer) is not cost effective while repeated endoscopies (in selected patients) seem most appropriate. This conclusion however raises two cardinal questions. Firstly, are there “special” requirements (that is, a protocol of gastric biopsy sampling) to be satisfied when carrying out the upper endoscopy procedure? Secondly, are there evidence based criteria for selecting patients to be included in surveillance programmes?

    The authors do not provide detailed information on the number of …

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