The long term results of endoscopic surveillance of premalignant gastric lesions

Abstract

Background: A large proportion of patients attending open access endoscopy have histological and gross pathological findings that are potentially premalignant. The proportion of these patients who go on to develop malignancies and the timescale over which this occurs are uncertain. Aims: This study aims to discover the incidence of gastric cancers in this "high risk" group and to examine the potential for their early diagnosis and treatment. Patients: A total of 1753 patients attended open access endoscopy. From these, 166 patients with dysplasia, intestinal metaplasia, atrophic gastritis, foveolar hyperplasia, regenerative changes, polyps, or ulcers who agreed to undergo annual surveillance endoscopy were studied. Methods: Patients were endoscoped annually. Additionally, patients with ulcers were re-examined at two monthly intervals until ulcer healing. Cancers detected were treated by gastrectomy. Results: Twenty two of 1753 patients attending open access endoscopy had gastric cancer (1.3%). In the study population, 14 cancers were detected over 10 years (8.4 %). These were of an earlier stage than those detected at open access (stage I and II 67% v 23%; p<0.05) and five year survival was significantly higher (50% v 10%; p=0.006). In atrophic gastritis and intestinal metaplasia the risk of malignancy was 11%. Conclusions: In patients with atrophic gastritis or intestinal metaplasia, annual surveillance can detect most new tumours at an early stage with a major improvement in survival. Potential benefits of such a surveillance programme are large and warrant further investigation in a multicentre randomised controlled trial.

Transforming Growth Factor-β1-Mediated Slug and Snail Transcription Factor Up-Regulation Reduces the Density of Langerhans Cells in Epithelial Metaplasia by Affecting E-Cadherin Expression

“…5,41,42 The increased risk of malignant transformation within the metaplastic epithelium could result from the accumulation of somatic gene mutations directly caused by factors responsible for EpM. 4,43 However, intrinsic immune features altered in the metaplastic epithelium could also contribute to cancer development by preventing an efficient antitumor immune response.…”

Test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

“…Furthermore annual endoscopic surveillance allows the detection of most new cancers at an early stage with improvement in the 5-year survival from 10% to 50%. 71 …”

Surveillance of Gastric Intestinal Metaplasia: Is It Warranted?

“…Amongst 93 patients with IM who accepted annual endoscopic surveillance, 10 gastric cancers (11%) were discovered over a 10-year period. Tumors detected by routine surveillance were of an earlier stage that open access endoscopy, and the five-year survival was also significantly higher (50% vs 10%, p=0.006) [8] . In an Italian study of 471 patients with IM undergoing surveillance biennially, 45 (9.55%) developed neoplasia over a 52-month follow-up period, specifically 17 cases of dysplasia alone, 26 gastric cancers, and one high-grade lymphoma [9] .…”

“…In a UK study, patients over age 40 who underwent an initial gastroscopy for dyspeptic symptoms were offered annual surveillance endoscopies for high-risk lesions (namely ulcers, polyps, dysplasia, IM, AG, foveolar hyperplasia and regenerative changes) [8] . Amongst 93 patients with IM who accepted annual endoscopic surveillance, 10 gastric cancers (11%) were discovered over a 10-year period.…”