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

Endoscopic submucosal dissection (ESD) is an effective treatment for superficial esophageal cancer, but postoperative stenosis remains a significant concern. Particularly, probability of the stenosis is less investigated in cases with a 50%-75% circumferential mucosal defect.

Aims & Methods

This study aimed to identify influential factors for postoperative stenosis after the moderate circumferential resection in esophageal ESD. This multi-center retrospective observational study analyzed data from 513 patients across 19 institutions who underwent esophageal ESD from April 2018 to March 2022 and showed 50% to 75% of the circumferential mucosal defect. We firstly overviewed the current status on the postoperative stenosis, the steroid use, and postoperative adverse events in these patients. Subsequently, we identified influential factors for postoperative stenosis. Patients were categorized into stenosis and no stenosis groups, and univariate and multivariate analyses were performed for each parameter. We further investigated influential factors of stenosis in two cohorts: steroid and no steroid groups. Finally, the parameters were compared between the steroid and no steroid groups to assess the tendency of the steroid use in general practice.

Results

Postoperative stenosis was observed in 28 cases (5%). Univariate analysis comparing the stenosis group (n = 28) and no stenosis group (n = 485) revealed significant differences in the prior endoscopic treatment near the lesion (p = 0.02), cervical esophageal location (p = 0.04), defect circumference (p =0.01), and procedure duration (p = 0.02). There was no significant difference in the steroid use between two groups. Multivariate analyses identified history of prior endoscopic treatment close to the lesion (p = 0.01, odds ratio [OR], 5.10), cervical esophageal lesions (p = 0.03, OR, 3.97), large circumferential defect (p <0.01, OR, 3.78), and longer procedure duration (p <0.01, OR, 3.83) as independent risk factors for stenosis formation. Among the steroid group, significant associations of the postoperative stenosis were revealed with the prior endoscopic treatment near the lesion (p = 0.02), cervical esophageal location (p = 0.04), and >5/8 of defect circumference (p = 0.02). In the no steroid group, only the procedure duration (p = 0.01) showed a significant difference between the stenosis and non-stenosis groups. Comparison between the steroid (n = 223) and no steroid groups (n = 290) revealed significant differences in the prior endoscopic treatment near the lesion (p <0.01), cervical esophageal lesions (p <0.01), and resected specimen dimensions (p <0.01). The stenosis rates were 7% in the steroid group and 4% in the no steroid group, without a significant difference. No significant difference in adverse events was observed between the two groups.

Conclusion

In esophageal ESD with a 50%-75% circumferential mucosal defect, the steroid was used in over 40% of patients, and postoperative stenosis still occurred in 5%. Because wider circumference, location of the cervical esophagus, prior endoscopic treatment close to the lesion, and prolonged operative time were identified as independent risk factors on the stenosis, steroid therapy should be preferred in these cases. Particularly, lesions with a history of endoscopic treatment, on cervical esophagus, and with >5/8 of defect circumference should require more aggressive countermeasures than currently applied.