PT  - JOURNAL ARTICLE
AU  - Wouter J den Hollander
AU  - I Lisanne Holster
AU  - Caroline M den Hoed
AU  - Lisette G Capelle
AU  - Tjon J Tang
AU  - Marie-Paule Anten
AU  - Ingrid Prytz-Berset
AU  - Ellen M Witteman
AU  - Frank ter Borg
AU  - Gijsbert den Hartog
AU  - Marco J Bruno
AU  - Maikel Petrus Peppelenbosch
AU  - Wilco Lesterhuis
AU  - Michael Doukas
AU  - Ernst J Kuipers
AU  - Manon C W Spaander
TI  - Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions
AID  - 10.1136/gutjnl-2017-314498
DP  - 2018 Jun 06
TA  - Gut
PG  - gutjnl-2017-314498
4099  - http://gut.bmj.com/content/early/2018/06/06/gutjnl-2017-314498.short
4100  - http://gut.bmj.com/content/early/2018/06/06/gutjnl-2017-314498.full
AB  - Objective International guidelines recommend endoscopic surveillance of premalignant gastric lesions. However, the diagnostic yield and preventive effect require further study. We therefore aimed to assess the incidence of neoplastic progression and to assess the ability of various tests to identify patients most at risk for progression.Design Patients from the Netherlands and Norway with a previous diagnosis of atrophic gastritis (AG), intestinal metaplasia (IM) or dysplasia were offered endoscopic surveillance. All histological specimens were assessed according to the updated Sydney classification and the operative link on gastric intestinal metaplasia (OLGIM) system. In addition, we measured serum pepsinogens (PG) and gastrin-17.Results 279 (mean age 57.9 years, SD 11.4, male/female 137/142) patients were included and underwent at least one surveillance endoscopy during follow-up. The mean follow-up time was 57 months (SD 36). Four subjects (1.4%) were diagnosed with high-grade adenoma/dysplasia or invasive neoplasia (ie, gastric cancer) during follow-up. Two of these patients were successfully treated with endoscopic submucosal dissection, while the other two underwent a total gastrectomy. Compared with patients with extended AG/IM (PGI/II≤3 and/or OGLIM stage III–IV), patients with limited AG/IM (PG I/II>3 and OLGIM stage 0–II) did not develop high-grade adenoma/dysplasia or invasive neoplasia during follow-up (p=0.02).Conclusion In a low gastric cancer incidence area, a surveillance programme can detect gastric cancer at an early curable stage with an overall risk of neoplastic progression of 0.3% per year. Use of serological markers in endoscopic surveillance programmes may improve risk stratification.