Introduction

Gastric polyps are detected in approximately 3-6% of patients undergoing routine upper endoscopy. The standard approach to managing most gastrointestinal polyps is through endoscopic polypectomy, although bleeding is a common adverse event. While cold snare polypectomy (CSP) has been reported as a safe alternative to hot snare polypectomy (HSP) for removing small colorectal polyps, further evidence is necessary to validate its effectiveness and safety specifically for gastric polyps.

Aims & Methods

Aim: Compare the efficacy and safety of CSP and HSP for removing small gastric polyps (5-15mm).
Materials and Methods: Cross-sectional study, with a prospective enrollment, including 330 consecutive gastric endoscopic polypectomies conducted in a tertiary center, between January 2021 and December 2023. Patients who underwent either CSP or HSP for gastric polyps ranging from 5 to 15 mm in size were enrolled, while those with underlying polyposis syndromes were excluded. Dedicated snares were utilized for CSP procedures. A 30-day phone survey was carried out to evaluate post-polypectomy adverse events. Statistical analysis was performed using the SPSS software v28.

Results

Overall, 330 gastric lesions in 218 patients were removed through snare polypectomy (CSP-165 lesions; HSP-165 lesions), mainly located in the body (51.5%). The median lesion size was 8.0 mm (IQR 4.0) and 8.0 mm (IQR 3.0) for CSP and HSP, respectively (p=0.08), ranging from 5 to 15 mm in both groups. The most common histological diagnoses were hyperplastic (58.2%) and fundic gland (29.4%) polyps. While the complete endoscopic resection rate was 100% in both groups, the en-bloc resection rate was slightly higher for CSP (CSP 98.2% vs. HSP 97.6%; p=0.45). At histological analysis, the complete (R0) resection rate was equal for both groups (CSP 98.2% vs. CSP 98.2%; p=1.00). Immediate bleeding, endoscopically treated, was more common with HSP (CSP 2.4% vs. HSP 3.6%; p=0.52). Delayed bleeding occurred exclusively in the HSP group (CSP 0.0% vs. HSP 1.2%; p=0.16). There were no perforations or procedure-related deaths. At univariate analysis, piecemeal resection (OR 64.6; 95%CI [3.5-1184.8]; p=0.005) was associated with a higher risk of delayed bleeding.

Conclusion

CSP demonstrates comparable effectiveness and potentially greater safety profile compared to HSP for gastric polypectomy. Consequently, CSP was non-inferior to HSP and may serve as an additional option for the removal of gastric polyps sized ≤15mm. Piecemeal resection is a hypothetical risk factor for delayed post-polypectomy bleeding.

Introduction

The first international guideline for managing preneoplastic conditions of the stomach (MAPS I) was published in 2012, followed by an update (MAPS II) in 2019. As adherence to these guidelines remains uncertain, we evaluated adherence by comparing the management of preneoplastic gastric conditions before and after the introduction of MAPS I and II in selected European centers.

Aims & Methods

Patient data were retrieved from nine endoscopy units in seven European countries during three periods: pre-MAPS I (2010/2011), post-MAPS I (2017/2018), and post-MAPS II (2022/2023). Screening and dyspepsia-related endoscopies were included. Data on endoscopy, histopathology, Helicobacter pylori (H. pylori) treatment, and surveillance were collected using a standardized form. Adherence to nine MAPS recommendations was assessed, with improvement defined as a ≥10% increase in guideline-concordant management.

Results

A total of 2,426 patients were included. Most centers (57%) improved in at least seven of the nine recommendations over time. Virtal Chromoendoscopy use improved in six centers, with four reporting its use in >50% of cases. All centers improved in performing biopsies from the antrum and corpus, five conducted random biopsies in nearly all patients, and four performed these plus an incisura biopsy in >90% of cases. Endoscopic scores for patient stratification were rarely used, while five centers improved in histological scoring or intestinal metaplasia subtyping. H. pylori treatment recommendation remained high (71%-100%), and endoscopic surveillance adherence improved in four of seven centers

Conclusion

Adherence to MAPS guidelines improved in most centers. However, gaps in virtual chromoendoscopy, targeted biopsies, and endoscopic/histopathological scoring remain, potentially affecting surveillance recommendations. This underscores the need for a more tailored approach to enhance implementation.

References

1. Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
2. Anderson, L. A., Tavilla, A., Brenner, H., Luttmann, S., Navarro, C., Gavin, A. T., Holleczek, B., Johnston, B. T., Cook, M. B., Bannon, F., Sant, M., & EUROCARE-5 Working Group: (2015). Survival for oesophageal, stomach and small intestine cancers in Europe 1999-2007: Results from EUROCARE-5. European journal of cancer (Oxford, England : 1990), 51(15), 2144–2157. https://doi.org/10.1016/j.ejca.2015.07.026
3. Pimentel-Nunes, P., & Dinis-Ribeiro, M. (2015). Endoscopic Submucosal Dissection in the Treatment of Gastrointestinal Superficial Lesions: Follow the Guidelines!. GE Portuguese journal of gastroenterology, 22(5), 184–186. https://doi.org/10.1016/j.jpge.2015.08.002
4. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829-854. doi:10.1055/s-0034-1392882
5. Latorre G, Vargas JI, Shah SC, et al. Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study. Gastroenterol Hepatol. 2024;47(8):793-803. doi:10.1016/j.gastrohep.2023.08.005

Introduction

Postoperative anastomotic leaks and fistulae in the upper digestive tract are severe complications that can lead to significant morbidity and mortality. Traditionally, surgical intervention has been the primary approach to address these complications. However, self-expanding metal stents (SEMS) have emerged as a less invasive alternative, offering a potential pathway to achieve closure of these leaks and fistulae. Despite their growing use, the efficacy and safety profile of SEMS in this context is not fully understood.

Aims & Methods

This study aims to evaluate the success rates, safety, and predictive factors of therapeutic success for SEMS in managing postoperative upper digestive tract leaks and fistulae, drawing on a 10-year experience at a tertiary center. We conducted a retrospective review of patients with postoperative anastomotic leak or fistula who underwent endoscopic SEMS placement at our tertiary center between 2014 and 2022, and prospectively from 2022 onwards. Therapeutic success was defined as complete closure of the leak/fistula, while failure indicated non-closure.

Results

We included a total of 43 patients (69.8% male) with a median age of 61 years (IQR 17). There were no statistically significant differences regarding distribution by gender, age, Charlson comorbidity index, benign vs malignant disease, time from surgery to endoscopic treatment and leak size between the different types of stents (p>0.05). The technical efficacy was 100%, with a therapeutic success rate of 55.8%. Bariatric stents exhibited the highest success rate (85.7%), followed by fully covered SEMS (60.0%) and partially covered SEMS (46.2%) (p = 0.166). Success was significantly higher in patients with a smaller leak size (10 mm vs. 12 mm, p<0.05). Therapeutic failure was associated with greatest need for endoscopic adjuvants (57.9% vs. 37.5%, p=0.183). The overall mortality rate was 34.9%.

Conclusion

This study indicates that self-expanding metal stents (SEMS) offer a viable and safe treatment option for postoperative upper digestive tract leaks and fistulae. With a technical efficacy of 100% and a therapeutic success rate of 55.8%, SEMS demonstrated promising results. The success rate was influenced by stent type, with bariatric stents showing the highest rate, followed by fully covered SEMS and partially covered SEMS. Smaller leak size emerged as a significant predictor of therapeutic success, emphasizing the importance of early detection and timely intervention. Although the overall mortality rate was 34.9%, this study's outcomes suggest that SEMS can play a crucial role in managing these complications, with early diagnosis and prompt stent placement being pivotal for success. Further research is needed to better understand the factors contributing to therapeutic success and to optimize endoscopic strategies for patients with upper digestive tract leaks and fistulae.

Introduction

Gastric cancer (GC) is the fifth most common malignancy worldwide and the fourth leading cause of cancer death. In Colombia, it ranks third in incidence and first in mortality, with a 5-year survival below 25% in advanced stages. Early detection relies on identifying premalignant lesions. OLGA and OLGIM histological staging systems enable risk stratification. While stages III–IV are known high-risk states, the role of stage II remains unclear. This study focuses on OLGA II to address this gap.

Aims & Methods

This systematic review and meta-analysis, registered on PROSPERO (CRD42024549931), adhered to PRISMA 2020 guidelines. The primary objective was to determine whether OLGA stage II confers a statistically significant risk of GC compared to stages 0–I. Secondary objectives included evaluating risks across all advanced stages (II–IV) and contrasting OLGA versus OLGIM staging.
We searched PubMed, EMBASE, and Cochrane up to 31 May 2024 using terms including "OLGA", "OLGIM", "gastric cancer", and "gastric intraepithelial neoplasia". Inclusion criteria covered cohort, case-control, and cross-sectional studies reporting GC incidence stratified by OLGA/OLGIM stage. Data extraction and quality assessment were performed independently by two reviewers using the Newcastle-Ottawa Scale, with evidence certainty assessed via GRADE. Meta-analytical synthesis used random-effects modelling, and heterogeneity was assessed with I² and Tau² statistics.

Results

Twenty-eight studies met inclusion criteria, comprising 13 cohort, 11 case-control, and 4 cross-sectional studies.

• OLGA II vs 0–I (Cross-sectional studies): A significantly increased GC risk was observed (Z = 3.14; P = 0.002; I² = 65%), suggesting OLGA II as an early but meaningful predictor of malignant transformation.
• OLGA II (Cohort studies): No statistically significant difference was found (P = 0.28; I² = 0%), though sample size was limited.
• OLGIM II: Demonstrated increased risk only in case-control settings (Z = 11.26; P < 0.00001), but not in cohort studies.

Findings for OLGA and OLGIM stages III–IV corroborated existing evidence of elevated risk. However, this is the first meta-analysis to demonstrate a potential oncogenic risk beginning at OLGA stage II, particularly evident in cross-sectional data.
Sensitivity analyses affirmed result consistency, and the certainty of evidence was rated moderate. Subgroup comparisons revealed that OLGA may outperform OLGIM in early risk discrimination.

Conclusion

Our study highlights a pivotal finding: OLGA stage II—previously considered an intermediate state—emerges as a statistically significant risk factor for gastric cancer. These findings suggest that the progression to malignancy may begin earlier than currently recognised. Incorporating OLGA II into surveillance strategies could lead to improved early detection, especially in high-incidence countries. The data support a shift toward broader inclusion criteria for endoscopic follow-up and reinforce the clinical utility of histological staging in GC prevention frameworks.

References

• Yue H, Shan L, Bin L, Shi L. The OLGA and OLGIM staging systems are useful for assessing the gastric cancer risk: a systematic review and meta-analysis. Gastric Cancer. 2018;21(4):579–87. doi:10.1007/s10120-017-0779-4
• Rugge M, Genta RM, Zambon CF, et al. OLGA staging for gastritis: a tutorial. Dig Liver Dis. 2008;40(9):650–8. doi:10.1016/j.dld.2008.02.020
• Rugge M, Meggio A, Pennelli G, et al. Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: a 5-year prospective study of 1755 patients. Gut. 2019;68(3):477–84. doi:10.1136/gutjnl-2017-315252
• Pimentel-Nunes P, Libânio D, Marcos-Pinto R, et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group, European Society of Pathology, and Sociedade Portuguesa de Endoscopia Digestiva guidelines update 2019. Endoscopy. 2019;51(4):365–88. doi:10.1055/a-0859-0574
• Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992;52(24):6735–40.