Clinicopathologic Characteristics of Patients with Gastric Superficial Neoplasia and Risk Factors for Multiple Lesions after Endoscopic Submucosal Dissection in a Western Country

Brito-Gonçalves, Gisela; Libânio, Diogo; Marcos, Pedro; Pita, Inês; Castro, Raquel; Sá, Inês Marques de; Dinis-Ribeiro, Mário; Pimentel‐Nunes, Pedro

doi:10.1159/000501939

Cited by 12 publications

(8 citation statements)

References 53 publications

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“…After a curative ER, the risk of LNM is low or very low, but there is a very low risk of recurrence and a moderate risk of metachronous lesions during follow-up (10 %-20 %) [192,[225][226][227][228][229][230][231]. There is evidence that Helicobacter pylori eradication decreases the risk of metachronous lesions and thus eradication is recommended if the patient has active H. pylori infection [232].…”

Section: Stomachmentioning

confidence: 99%

“…There is evidence that Helicobacter pylori eradication decreases the risk of metachronous lesions and thus eradication is recommended if the patient has active H. pylori infection [232]. No other strategies showed benefit in decreasing risk of metachronous lesions, but there is consistent evidence that older patients and patients with synchronous or multiple lesions at diagnosis and/or with extensive preneoplastic conditions are at higher risk [192,[225][226][227][228][229][230][231]. However, to date there are no data showing that these risk factors should influence surveillance intervals.…”

Section: Stomachmentioning

confidence: 99%

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Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Pimentel‐Nunes

Libânio

Bastiaansen³

et al. 2022

Endoscopy

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347

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Main recommendationsESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett’s esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.

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Section: Stomachmentioning

confidence: 99%

Section: Stomachmentioning

confidence: 99%

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Pimentel‐Nunes

Libânio

Bastiaansen³

et al. 2022

Endoscopy

Self Cite

347

212

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“…The presence of synchronous gastric lesions was the only independent risk factor for the occurrence of MGL in our study; at 3 years of follow-up, 30 % of the patients with synchronous lesions developed MGLs. Evidence estimates that one third of synchronous gastric lesions are only detected during the first follow-up endoscopy [33]. This highlights the need for full inspection of the entire gastric mucosa at the index examination even if one lesion has already been identified, as well as the need for surveillance in the first months after ESD.…”

Section: Progression Function Censoredmentioning

confidence: 99%

Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score

et al. 2023

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Background and study aim: Surveillance after gastric endoscopic submucosal dissection (ESD) is recommended for all patients due to the persistent risk of metachronous gastric lesions (MGLs). We aimed to develop and validate a prediction score to estimate MGL risk after ESD for early neoplastic gastric lesions, to define an individualized and cost saving approach. Patients and methods: Clinical predictors and a risk score were derived from meta-analysis data. A retrospective, single centre, cohort study including patients with >3 years standardized surveillance after ESD was conducted for score validation. Predictive accuracy of the score by the receiver operating characteristic curve was assessed and cumulative probabilities of MGL were estimated. Results: The risk score (0-9 points) included 6 clinical predictors (scored 0-3): positive family history of gastric cancer, older age, male gender, corpus intestinal metaplasia, synchronous gastric lesions and persistent Helicobacter pylori infection. Study population included 263 patients; the MGL rate was 16%. The score diagnostic accuracy for predicting MGL at 3 years of follow-up as measured by the AUC was 0.704 (95% CI 0.603-0.806). At 3 years and a cut-off <2, it achieved maximal sensitivity and negative predictive value; 15% patients could be assigned to a low-risk group, in which the progression to MGL was significantly lower than for the high-risk group (p=0.037). Conclusion: The FAMISH score might be a concise and useful tool, accurately identifying patients with low-to-intermediate risk for MGL at 3 years of follow-up, who might expand the surveillance interval to reduce the burden of care.

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“…However, SDSGIM did not demonstrate predictive ability for malignancies with multiple lesions. Gisela Brito-Gonçalves et al [ 22 ] reported a trend for patients with extensive GIM (EGGIM > 4) who had a higher risk of multiple lesions. The trend was not found significant using multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

A novel method of grading gastric intestinal metaplasia based on the combination of subtype and distribution

2021

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Background Studies have shown the value of subtypes and distribution of gastric intestinal metaplasia (GIM) for prediction of gastric cancer. We aim to combine GIM subtypes and distribution to form a new scoring system for GIM. Methods This was a cross-sectional study. No GIM, type I, II, and III GIM of gastric antrum and corpus scored 0–3 points respectively. Then the severity of the whole stomach was calculated in two ways: 1. The gastric antrum and corpus scores were added together, with a score ranging from 0 to 6, which named “Subtype Distribution Score of Gastric Intestinal Metaplasia (SDSGIM)”. 2. Direct classification according to a table corresponding to that of OLGIM. We compared the SDSGIM among benign lesions, dysplasia, and cancer and drew receiver operating characteristic (ROC) curve to determine the optimal cut-off value. According to the cut-off value and the classification from the table, the predictive ability of these two methods were calculated. Results 227 patients were included. For SDSGIM, benign lesion group was significantly different from dysplasia or cancer group. Area under curve of ROC curve was 0.889 ± 0.023. The optimal cut-off value was 3. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SDSGIM for malignancy were 89.5%, 78.0%, 74.6%, 91.2% and 82.8%. And those for the second classification method were 84.2%, 82.6%, 77.7%, 87.9%, and 83.3% respectively. Conclusions This study firstly combined GIM subtypes with its distribution forming a novel scoring system, which showed high prediction accuracy for malignant lesions.

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Clinicopathologic Characteristics of Patients with Gastric Superficial Neoplasia and Risk Factors for Multiple Lesions after Endoscopic Submucosal Dissection in a Western Country

Cited by 12 publications

References 53 publications

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score

A novel method of grading gastric intestinal metaplasia based on the combination of subtype and distribution

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