Introduction

Post endoscopy upper gastrointestinal cancers (PEUGIC) are often missed opportunities to diagnose earlier or even prevent cancer. PEUGIC in patients undergoing surveillance for pre-malignant conditions are a potentially important surveillance quality indicator. A national process for identifying all PEUGIC in the English National Health Service and performing root cause analysis was developed.

Aims & Methods

Potential PEUGIC between 2017 and 2023 occurring 3-36 months after an index endoscopy which did not result in a cancer diagnosis were identified from National Cancer Registration Dataset and Hospital Episode Statistics held by the National Cancer Registration and Analysis Service. Data from local root cause analysis were uploaded onto a secure portal for national analysis. Only PEUGIC following surveillance endoscopy were included in this analysis. Logistic regression analysis was used to identify associations.

Results

3151 potential PEUGIC were examined by local reviewers in 144 English hospitals. 635 (20%) were excluded and data were available for 2516 PEUGIC. 618 PEUGIC (24.6%) were undergoing surveillance for: Barrett’s oesophagus (83%); chronic atrophic gastritis (7%) or other conditions (10%). PEUGIC sites were oesophagus 85%, stomach 13% and duodenum 1%. 5% of PEUGIC were not related to the pre-malignant condition under surveillance.
Table 1 summarises the PEUGIC root cause analysis results based on the World Endoscopy Organisation categorisation. Inadequate endoscopy or decision making occurred in 30% of PEUGIC (categories B/D) and was associated with patient harm OR 2.61 (95% CI 1.74 -3.92).
Seattle biopsy protocol compliance was only 58% in Barrett’s surveillance PEUGIC. Additional focal or cancer associated lesions were present at index endoscopy in the PEUGIC segment in 23%.
Oesophageal and gastric PEUGIC often presented with stage 2 cancers or greater (48% and 43% respectively). 45.2% of oesophageal and 47.0% of gastric PEUGIC were considered at least possibly avoidable. Treatment was adversely affected with palliative treatment in 22% of oesophageal and 30% of gastric PEUGIC. 6% led to premature death.
Endoscopy practices associated with stage ≥2 cancer were: sedation without opioids OR 1.75 (95% CI 1.03-2.97); lack of image enhancement OR 1.78 (95% CI 1.18-2.70) and lack of dedicated surveillance sessions OR 2.08 (95% CI 1.46-2.98).

Table 1 Root causes of all surveillance PEUGIC

PEUGIC categorisation	Completed cases
A: Lesion detected, adequate assessment and decision making but PEUGIC occurred	378 (61%)
B: Lesion detected, inadequate assessment and decision making	158 (26%)
C: Possible missed lesion, endoscopy and decision making adequate	56 (9%)
D: Possible missed lesion, endoscopy and decision making inadequate	24 (4%)

Conclusion

Inadequate assessment or decision making was noted in 30% of surveillance PEUGIC, which adversely affected treatment in 20% of oesophageal and 30% of gastric PEUGIC. 48% of oesophageal and 43% of gastric PEUGIC patients presented with stage 2 cancer or greater suggesting potential failures of surveillance. Optimal sedation practice, image enhancement and dedicated surveillance sessions were associated with stage 1 PEUGIC and better outcomes.

Introduction

The TOGAS consortium (TOwards GAstric cancer Screening) was established to explore effective gastric cancer screening strategies within Europe. One key method involves the detection and eradication of Helicobacter pylori (H. pylori), the leading causative agent of gastric cancer. In Western Europe, infection rates are higher among males, smokers, and individuals of lower socioeconomic status—groups that tend to engage less with preventive health services.

Aims & Methods

This pilot study aimed to determine whether targeted screening in high-risk occupational settings improves participation and outcomes compared to population-based screening via general practice.
Key outcome measures included;

1. Response rate
2. Prevalence of the infection
3. Treatment effectiveness

This prospective pilot study recruited individuals aged 30–34 years from January 2024 to March 2025. Participants were invited either through general practices (general population group, GP) or through two occupational screening programs (targeted group, TG) representing higher-risk, male-dominated workforces: the Irish Defence Forces and Construction Workers Health Trust. Exclusion criteria included prior H. pylori treatment or gastrectomy. All participants underwent serologic screening (BIOHIT H. pylori IgG antibody). The TG was offered initial on-site screening at their workplace; the GP group attended a local hospital. All seropositive individuals were offered confirmatory 13-C urea breath testing (Richen IR Force 200) in a local hospital. Confirmed cases were offered a 10-day regimen of PYLERA (Metronidazole/Tetracycline/Bismuth subcitrate) with Esomeprazole 40 mg BD. Eradication was assessed ≥6 weeks post-treatment. Response rates, demographics, infection prevalence, and treatment outcomes were analyzed using Mann-Whitney U and Chi² tests (significance p < 0.05).

Results

3030 individuals were invited for screening: 2824 in the GP group(GPG), 206 in the TG. Key demographics and risk factors of each group are shown in Table 1. The invitation response and participation rates were significantly higher in the TG versus the GPG (31% v’s 14%; p < 0.001, 30% v’s 14% p <0.00, respectively). H. pylori seroprevalence rates were similar between groups: 18% (11/60) in the TG, 19% (64/333) in the GPG (p<0.70). Confirmatory 13-C UBT was completed in 91% (10/11) of those who tested positive in the TG and 98% (63/64) of the GPG. Overall, ‘true’ prevalence rates based on serology & confirmatory 13-C UBT results were 10%(6/59) in the TG v’s 14% (44/325) in the GPG(p = 0.47). Treatment adherence exceeded 90% in both groups, with 100% adherence in the TG and 90% in the GPG. Among those who completed post-treatment testing (n=37), eradication was achieved in 100% of the TG (2/2) and 89% of the GPG (31/35).

Table 1 Basic Demographics by Group

	Targeted group	General population
Gender, male	97%	33%
Median age, years	31	32
Smoking status Current/previous Non-smoker	41% (24) 59% (34)	34% (137) 66% (266)
Socioeconomic status(self-rated) Higher Middle Lower Prefer not to answer	69% (40/58) 22% (13/58) 0 9% (5/58)	85% (337/397) 11% (42/397) 0% (2/397) 4% (16/397)
Family history of H.pylori infection	3% (2)	9% (36)

Conclusion

Targeted occupational screening in high-risk populations demonstrated superior response and engagement rates compared to general practice-based screening. These early results suggest this approach may be a more effective and resource-conscious strategy in low-to-intermediate risk countries and merit further evaluation in broader implementation efforts.

References

1. Teo CH, Ng CJ, Booth A, White A. Barriers and facilitators to health screening in men: A systematic review. Soc Sci Med. 2016 Sep;165:168-176. doi: 10.1016/j.socscimed.2016.07.023. Epub 2016 Aug 1. PMID: 27511617. 5.
2. Lou L, Wang L, Zhang Y, et al. Sex difference in incidence of gastric cancer: an international comparative study based on the Global Burden of Disease Study 2017.BMJ Open 2020;10:e033323. doi: 10.1136/bmjopen-2019-033323
3. Salmani H, Ahmadi M, Shahrokhi N. The Impact of Mobile Health on Cancer Screening: A Systematic Review. Cancer Informatics. 2020;19. doi:10.1177/1176935120954191
4. CSO. (2023, May 30). Employment, Occupation, Industry and Commuting - CSO -Central Statistics Office. https://www.cso.ie/en/releasesandpublications/ep/pcpsr/censusofpopulation2022- summaryresults/employmentoccupationindustryandcommuting/

Disclosure

Dr. Deane reports receipt of research funding support from EU4 Health grant GA number: 101101252. Receipt of ​13-C Urea Breath Test bags for this study was provided for by Richen - Dr Deane was the winner of the Richen Global ​Research Competition 2023

Introduction

The European Union has signalled gastric cancer screening and prevention as a major health priority. The TOGAS consortium (TOwards GAstric cancer Screening in the European Union; togas.lu.lv), funded in response to this call, investigates different strategies for primary and secondary prevention of gastric cancer in Europe. One pilot study aims at determining the yield of having an oesophagogastroduodenoscopy (OGD) on the same day of a colonoscopy for colorectal cancer screening or polyp surveillance.

Aims & Methods

This is the first interim data on n=602 individuals recruited in 8 centres across Europe (France, Germany, Ireland, Latvia, Lithuania, the Netherlands, Portugal, and Spain). Individuals of the age of 50-74 years, attending for screening or surveillance colonoscopy, were invited to participate if they did not have a past diagnosis of gastric preneoplastic conditions requiring surveillance. Standardization of endoscopic procedures was assured by a rigorous protocol including all quality parameters defined by ESGE. This included standards for image documentation and biopsy sampling. Demographics, comorbidities, medication and the previous surgical and family history were recorded. Patients with marked preneoplastic changes (i.e. glandular atrophy or intestinal metaplasia [IM] at OLGA/OLGIM stage 3 or 4, and/or EGGIM score >5) were registered as requiring further endoscopic surveillance. Mann-Whitney U-test was applied for comparison of age between groups and Chi2 test for comparison of categorical variables (significance for p<0.05).

Results

The mean age of participants was 62 years (SD +/- 8.0), with 55.8% being male. Of 245 individuals who underwent an OGD prior to inclusion, 93.1% of these procedures were done >3years before and 60.4% were done at a tertiary centre. We identified 6 (1.0%) malignant/neoplastic lesions, 4 gastric cancers/dysplastic lesions and 2 oesophageal carcinomas. A positive H. pylori status was diagnosed in 34.2%. Endoscopically, a diagnosis of preneoplastic conditions was made in 217 participants (36.0%). Of these, 84 (14.0%) showed gastric atrophy, 45 (7.5%) gastric IM and 75 (12.5%) both conditions combined. Of those with gastric atrophy, this was classified as multifocal in 44 (27.6%) individuals, of those with IM in 45 (37.5%). OLGA stages 3 and 4 were confirmed for 1.9% and 0.8%, OLGIM stages 3 and 4 for 2.3% and 0.4%. Benign ulcers were diagnosed in 28 (4.7%) participants. The majority being gastric ulcers in 19 (3.2%) individuals, duodenal ulcers in 9 (1.5%), and oesophageal ulcers in 2 (0.3%). An additional 13 (2%) participants were diagnosed with Barrett’s oesophagus. It is of note that also 12 (2.0%) colorectal cancers were identified in the cohort. A positive H. pylori status was associated with the need for gastric surveillance (p=0.031).

Conclusion

This interim analysis of the first European pilot study on a combined screening for upper and lower GI tumours shows that this approach is feasible. Regarding the detection of upper GI malignancy and preneoplastic conditions, our findings are in line with previous systematic reviews, but we also demonstrate a reasonable rate of non-malignant findings that are also of relevance when defining the best screening strategy in Europe.

Disclosure

JB: Advisory fee from Flynn Pharma Ltd, Juvise Pharmaceuticals.
MCWS: Research Support from Sysmex, Norgine, Sentinel
OK: Speakers fee, advisory fee from Abbvie, Pfizer, Takeda, Janssen, Shire.

Introduction

Few studies have examined esophageal motility disorders in patients with type 2 diabetes operated with sleeve gastrectomy (SG) or gastric bypass (RYGB).

Aims & Methods

We have recently reported overall prevalence of gastroesophageal reflux disease (GERD) in this group of patients (1) and now aimed to investigate potential differences between the two surgical methods regarding the prevalence of dysmotility 5 years after surgery. Furthermore, we also aimed to analyse and report on the available GERD-data in detail.
In the Oseberg study (January 2013 – December 2022), 125 patients with BMI ≥ 35 kg/m² and type 2 diabetes were screened, sixteen patients were excluded or withdrew consent, leaving 109 patients allocated to SG (n=55) or RYGB (n=54). To assess reflux symptoms, GerdQ (Gastroesophageal reflux disease questionnaire) was completed. Gastroscopy and 24-hour pH monitoring were used to examine GERD. High-resolution manometry with the Chicago classification v3.0 was used to assess esophageal motility.

Results

At inclusion the average age was 47.7 years (SD 9.6), BMI was 42.3 kg/m2 (5.3), and 66% were women. At the 5-year follow-up, 29 (53%) patients in SG-group and 32 (59%) in RYGB-group underwent gastroscopy, 22 (40%) vs. 25 (46%) underwent 24-hour pH monitoring, 23 (42%) vs. 26 (48%) underwent manometry, and 42 (76%) vs. 42 (78%) completed GerdQ. The proportion of patients with GERD symptoms (GerdQ ≥8) was low in both groups, with a slightly lower prevalence after RYGB (2%) than after SG (14%). There was no difference in the prevalence of erosive esophagitis between the groups (38% in SG and 41% in RYGB), all findings with less advanced esophagitis (Los Angeles grades A and B), but one patient in each group had new onset Barrett's esophagus. The proportion of patients with pH<4 for more than 6% of the recording (Acid exposure time, AET) was significantly higher after SG compared with RYGB (59% versus 8%, p < 0.0001). Esophageal dysmotility was diagnosed in 14 (61%) after SG compared with 19 (73%) patients after RYGB. Most of these patients (n=22) had hypertensive or hypotensive lower esophageal sphincter (LES), with no difference between groups. The remaining 11 patients had ineffective esophageal motility (IEM) or elevated distal contractile integral (DCI). None of the patients with dysmotility reported swallowing difficulties or chest pain with food intake.

Conclusion

The Oseberg study demonstrates a high prevalence of asymptomatic esophageal dysmotility after SG or RYGB with uncertain clinical relevance. Furthermore, a seven times higher prevalence of pathological acid reflux after SG compared with RYGB was demonstrated, but the prevalences of erosive esophagitis and esophageal dysmotility were approximately similar between groups. Few of the examined patients reported GERD symptoms, hence objective assessment of GERD should be included in long-term follow-up after SG to detect and prevent the development of Barrett's esophagus, dysplasia, and adenocarcinoma.

References

1. Hauge JW et al., Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2025 Apr 1:S2213-8587(24)00396-6

Introduction

Corpus atrophic gastritis (CAG) requires endoscopic-histological surveillance due to the risk of developing gastric neoplastic lesions (GNL). This study aimed to identify variables associated with GNL development at long-term follow-up using a feature ranking method based on a novel One-Class Support Vector Machine (SVM) model.

Aims & Methods

A dataset containing clinical, endoscopic, and histological variables from consecutive CAG patients (2001-2023) adhering to a surveillance program was considered. GNL presence at the longest available follow-up was recorded. Gastric biopsies and histological evaluations were conducted according to the updated Sydney system. CAG patients with any missing data or a GNL diagnosis at the baseline gastroscopy were excluded from the final analysis. A Fisher score-based feature ranking method and One-Class SVM were used to select the optimal subset of baseline variables associated with GNL development, aiming to achieve average sensitivity (Se) and specificity (Sp) above 80%.

Results

Overall, 355 CAG patients were initially considered. Of these, 36 were excluded due to the presence of GNL at baseline gastroscopy, and 216 for missing data. Thus, a total of 103 patients were considered and grouped into: CAG patients with [22 patients (F 68.1%), median age 68 (35-83) years] and without GNL at follow-up [81 patients (F 72.8%), median age 59(26-84) years]. After a median follow-up of 60 (12-192) months, 13 epithelial GNL (gastric adenocarcinoma or high/low-grade dysplasia) and nine type-1 gastric-neuroendocrine-tumors (T1gNET) were recorded. Parietal-cell-antibodies and pepsinogen-I < 30 μg/l were associated with both epithelial GNL and T1gNET. Antral inflammation and age > 60 were linked to epithelial GNL, while anti-thyroperoxidase-antibodies, smoking, and dyspeptic symptoms at CAG diagnosis were linked to T1gNET. Low-dose aspirin and H. pylori eradication therapy showed inverse associations with epithelial GNL and T1gNET, respectively.

Conclusion

This is the first study in which an AI model simultaneously considers clinical, endoscopic, and histological characteristics from a dataset of CAG patients, showing good sensitivity and specificity in identifying those variables associated with developing GNL. Nonetheless, we acknowledge the need for improved variable standardization and data balancing between groups to enhance model performance further.