Introduction
Background: Worldwide, gastric cancer (GC) is the fourth cause of death for neoplastic pathology and the fifth for incidence (1). To reduce GC mortality, a strategy is to timely diagnose preneoplastic lesions, especially in patients with significant risk factors. Since in 1st degree relatives was found an up to 2.5 times increased risk for GC (2), recent guidelines suggest an esophagogastroduodenoscopy (EGDS) screening in patients who have a 1st degree relative for GC (3). However, if the EGDS shows the absence of atrophy or intestinal metaplasia, no further EGDS is currently recommended. Otherwise, if precancerous conditions are diagnosed, European guidelines, MAPS II, suggest repeating EGDS shortening the interval (4).
Aims & Methods
The purpose of this cross-sectional study was to determine the endoscopic and histological findings and the prevalence of preneoplastic and neoplastic conditions in patients undergoing EGDS for 1st degree relative for GC.
In this cross-sectional study, patients who underwent an EGDS with biopsies according to the updated Sydney system protocol, due to 1st degree GC relative indication from January 2008 to September 2022, were included. The preneoplastic conditions were staged with OLGA and OLGIM systems. Exclusion criteria were patients with previous gastric surgery and patients with an incomplete biopsy sampling.
Results
Overall, 330 patients were considered [64% F; 56 (20-87) years]. Twenty patients were excluded from the study due to an incomplete biopsy sampling, thus 310 patients were finally included. The mere indication of 1stdegree relative for GC was found in 55.7% of patients, whilst 18% also had anemia, 32% gastrointestinal symptoms, 11% performed EGDS for Hp eradication control, 1% for previous gastric dysplasia and 8% for other conditions. Histological examination identified 2 (0.6%) intestinal type gastric cancers and 2 (0.6%) low-grade dysplasia (none of these patients had previous dysplasia). Regarding precancerous conditions, 11 % were OLGA I-II, 0.3% OLGA III-IV whilst 10% were OLGIM I-II and 0.3% were OLGIM III-IV. Hp infection was found in 25.5% of patients. Furthermore, in 2.25% of cases, corpus-restricted atrophic gastritis was diagnosed.
Conclusion
Our study support the role of EGDS with biopsies in patients with 1st degree relative for GC as 2 neoplastic lesions and 2 low-grade dysplasia were found in patients with low stages of OLGA/OLGIM, and 10% of patients would have required follow-up according to European guidelines.
References
1. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
2. Yaghoobi, M., McNabb-Baltar, J., Bijarchi, R., & Hunt, R. H. (2017). What is the quantitative risk of gastric cancer in the first-degree relatives of patients? A meta-analysis. World journal of gastroenterology, 23(13), 2435.
3. Banks, M., Graham, D., Jansen, M., Gotoda, T., Coda, S., Di Pietro, M., ... & Dinis-Ribeiro, M. (2019). British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut, 68(9), 1545-1575.
4. Pimentel-Nunes, P., Libânio, D., Marcos-Pinto, R., Areia, M., Leja, M., Esposito, G., ... & Dinis-Ribeiro, M. (2019). Management of epithelial precancerous conditions and lesions in the stomach (maps II): European Society of gastrointestinal endoscopy (ESGE), European Helicobacter and microbiota Study Group (EHMSG), European Society of pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy, 51(04), 365-388.