Prevalence, Characteristics and Endoscopic Management of Gastric Premalignant Lesions in France

Abstract

Introduction: Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. Design: All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). Results: Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. Conclusion: In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.

A panel of stomach‐specific biomarkers (GastroPanel®) for the diagnosis of atrophic gastritis: A prospective, multicenter study in a low gastric cancer incidence area

“…3,4 Each of these lesions is associated with an increased risk of GC which correlates with the severity of the lesions, 5,6 but AG and IM are the most common and the most widely studied. [7][8][9] The recent guidelines provide recommendations for the management of patients harboring GPL, 10,11 with the aim to diagnose patients with early and curable neoplasia. However, the precise evolution of GPL is not completely understood and the surveillance of the patients known to be at risk for GC remains challenging.…”

“…It has been previously shown that the correlation between endoscopic evaluation of the mucosa and histologic findings is very poor. 7 Besides, histology-based diagnosis is subjected to a sampling error because of an often uneven distribution of GPL within the stomach mucosa. In this setting, several strategies have been developed to increase the patients' adhesion to surveillance and to improve targeting of the patients.…”

“…In this model of gastric carcinogenesis, GC is preceded by gastric precancerous lesions (GPL), that is, atrophic gastritis (AG), intestinal metaplasia (IM), low‐grade dysplasia, and high‐grade dysplasia, developed successively following chronic infection with H pylori 3,4 . Each of these lesions is associated with an increased risk of GC which correlates with the severity of the lesions, 5,6 but AG and IM are the most common and the most widely studied 7–9 . The recent guidelines provide recommendations for the management of patients harboring GPL, 10,11 with the aim to diagnose patients with early and curable neoplasia.…”

“…Moreover, in the western countries, the reference method to assess the status of the gastric mucosa remains an upper endoscopy with obtention of gastric biopsies, which is an invasive, costly, and often not well‐accepted procedure. It has been previously shown that the correlation between endoscopic evaluation of the mucosa and histologic findings is very poor 7 . Besides, histology‐based diagnosis is subjected to a sampling error because of an often uneven distribution of GPL within the stomach mucosa.…”

Reconsidering the “protective” hypothesis of Helicobacter pylori infection in eosinophilic esophagitis

“…37 EoE is also detected in 1-8% of symptomatic patients undergoing endoscopy, 37 whereas, for instance, comparable recent features of H. pylori infection are higher (41-63.67%). 74,75 Moreover, the current prevalence of H. pylori infection in Asia is: Central Asia 79.5%, South Asia 28.6-81%, and Western Asia 49.1-77.2%. 76 Additionally, owing to immigration, H. pylori infection prevalence in Western countries is high.…”