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.
- premalignant gastric lesions
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Contributors WJdH, ILH, CMdH, LGC, MD, EJK and MCWS contributed to the conception and design, acquisition of data, analyses and interpretation of the data, drafted the article, revised it critically for important intellectual content and gave final approval of the version to be published. TJT, M-PA, IP-B, EMW, FtB, GdH, MJB, MPP and WL contributed to the conception and design and acquisition of data, revised the article critically for important intellectual content and gave final approval of the version to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethics Review Board at the Erasmus University Medical Centre Rotterdam, The Netherlands.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note This work was part of a PhD thesis defended by the first author at the Erasmus University in Rotterdam on 14 September 2016.
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