Introduction Gastric ulcers can harbour malignancy and the National Institute for Health and Care Excellence (NICE) therefore recommends follow-up gastrocopy (FU-OGD). Predictors of benign gastric ulcers can potentially reduce the burden of FU-OGD.
Methods All patients with a first endoscopic diagnosis of gastric ulcer between January 2012 and September 2013 at this large teaching hospital were included. Patients with known gastric ulcers prior to study period or those referred for tertiary assessment were excluded. We defined neoplastic disease as histological evidence of gastric dysplasia or malignancy. Benign disease was defined as patients with complete ulcer healing, those with 2 sets of benign biopsies and no endoscopic suspicion of malignant disease, or in cases without FU-OGD one set of negative biopsies and at least 360 days cancer free survival. Patients with insufficient follow-up were excluded. We analysed the influence of demographic, endoscopic and histological factors on the likelihood of benign disease using chi-square test for categorical and t-test for continuous variables. Independence of variables was analysed using linear regression analysis.
Results Of 377 patients included 350 (92%) had benign disease. 19 patients were diagnosed with adenocarcinomas, 2 with dysplasia, 5 with lymphomas, and 1 with melanoma. Patient sex, indication for gastroscopy and helicobacter pylori status did not influence the likelihood of benign disease. Benign disease was significantly associated with ulcer location in the antrum (p = 0.001), endoscopic benign appearance (p < 0.001), non-cratered ulcer morphology (p < 0.001), benign histology on 1st biopsy (p < 0.001), younger age (64 vs 73 years, p = 0.02), lower number of ulcers (1.4 vs 2, p < 0.001) and smaller ulcer size (10 vs 28 mm, p < 0.001). After linear regression analysis only endoscopic benign appearance (p = 0.03), benign histology on 1st biopsy (p < 0.001), lower number of ulcers (p < 0.001) and smaller ulcer size (p = 0.004) were independent predictors of benign disease.
Conclusion We have demonstrated that several simple factors collected during index endoscopy and ulcer biopsy can predict benign disease. Risk stratification according to those factors could be used to re-examine the need for FU-OGD for all patients with gastric ulceration. If prospectively verified the described predictive factors could be used to identify low risk patients who do not require endoscopy. This may be a strategy to reduce the burden of FU-OGD.
Disclosure of Interest S. Thanaraj: None Declared, A. Sainsbury: None Declared, R. Cochrane: None Declared, C. Selinger Grant/research support from: Ferring, Shire, Nycomed, Warner Chilcott.