Background Chronic atrophic gastritis (CAG) is a precancerous lesion of gastric cancer. This study investigated the diagnostic accuracy of serum pepsinogens in Myanmar to diagnose CAG as non‐invasive makers. Methods A cross‐sectional study of 70 dyspeptic patients without red flag signs was recruited and performed endoscopy with mucosal biopsies. Histologic severity was assessed by Operative Link for Gastritis Assessment (OLGA) staging. Serum pepsinogens (PG I and PG II) were measured by ELISA Gastro Panel, Biohit Healthcare (Finland). Serum pepsinogens I/II ratio (PGR) was calculated. Results The mean (±SD) age of the study population was 52.57 (±16.33) years. The CAG was diagnosed in 61.4% of dyspeptic patients. The median values of PG I, PG II and PGR in dyspeptic patients were 114.5 ng/mL, 12.7 ng/mL and 9.5, respectively. The median values of PG I and PG II were significantly lower in patients with CAG (P = 0.006 and 0.029) but that of PGR was not significantly changed. Both PG I and PGR were reversely correlated with OLGA stages (P = 0.013 and 0.048). For the best discrimination of CAG, the cut‐off values of PG I in Myanmar was ≤114 ng/mL (Sensitivity 55.8%, specificity 63%, accuracy 58.6% and AUC 0.59) and that of PGR was ≤9.5 (Sensitivity 55.8%, specificity 55.6%, accuracy 55.7% and AUC 0.56). Conclusion Either PG I or PGR is useful as a non‐invasive biomarker for screening of CAG with moderate diagnostic accuracy.

Gastric cancer (GC) is the third most common cancer and the third leading cause of cancer-related deaths in Myanmar. 1 Nonspecific dyspeptic symptoms of gastric cancer can lead to late diagnosis with poor outcomes. Although the 5-year survival rates for advanced gastric cancer are less than 20%, early gastric cancer (EGC) has a good prognosis with 5-year survival rates over 90%. 2 Because of large discrepancies between survival rates of early and advanced gastric cancers, detection of gastric precancerous conditions and surveillance of EGC become an important issue especially in the Asian countries where the cancer prevalence is high.The presence of atrophic gastritis in the development of intestinal-type gastric cancers has been well recognized. In addition to AG, gastric intestinal metaplasia (IM) is also established as an early step in gastric carcinogenesis. Many studies have shown a significant rate of progression from IM to neoplasia in the high-risk populations in Asian countries, such as Japan and China. 3 Patients with AG were associated with significantly increased risk (5.8 times) of gastric cancer 4 and those with IM have 10 times the

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Summary Background To avoid the late complications of endoscopic sphincterotomy (EST) such as cholangitis, liver abscess and recurrent common bile duct stones (CBDS), alternative methods should be considered in the management of CBDS, especially in younger patients. Aim To study the effect of biliary stent placement without EST in patients with CBDS. Methods Forty‐nine patients with CBDS underwent biliary stent placement without EST and complications were evaluated. The rate of stone disappearance, the change in number, size and indices of stones and common bile duct (CBD) diameter were evaluated at the second endoscopic retrograde cholangiopancreatography (ERCP) 3 months later. Results CBDS(s) disappeared in 11 (22.45%) of 49 patients. Almost all of the stones which disappeared after stenting without EST were <14 mm and CBD diameter <18 mm. Average diameter of the largest CBDS, mean number of CBDS, stone index and CBD diameter markedly reduced (P < 0.001, P < 0.001, P < 0.001 and P = 0.001 respectively). The size of the largest stone, stone indices and diameter of CBD in the stone disappearance cases were significantly smaller than those of the stone persistence cases (P = 0.003, P = 0.006, P = 0.004 respectively). Complications such as mild post‐ERCP pancreatitis (6.12%), stent migration (10.2%) and cholangitis (4.08%) were observed. Conclusion Temporary stent placement without EST is effective for clearance of CBDS while preserving the duodenal papilla function, especially in small CBDS and less dilated CBD to avoid EST related complications.