Introduction
Gastric cancer is associated with a poor prognosis due to the late stage of the disease at the time of diagnosis. Consequently, the detection and surveillance of the established premalignant gastric lesions becomes imperative. Despite Eastern Europe being a region of high – intermediate gastric cancer incidence, the guidelines (MAPS-II) (1) are mainly based on the data from Western countries due to a lack of research in this area in Eastern countries.
Aims & Methods
This study aimed to assess a) the incidence of gastric cancer in patients with proven histologically proven premalignant gastric lesions b) the efficacy of endoscopic diagnosis of premalignant gastric lesions and c) trends of subsequent management of patients at an intermediate risk for the development of gastric cancer in an academic center in Lithuania.
We conducted a retrospective cohort study of patients who underwent esophagogastroduodenoscopy with histological sampling between 2012 and 2020 in a single academic centre. The pathology database was filtered for keywords “atrophy” and/or “intestinal metaplasia” in pathological conclusions or descriptions to identify patients with possible premalignant gastric lesions. Demographic (age and gender), pathology report (histological findings, presence of H.pylori), endoscopic evaluation (diagnosis, location of biopsies, endoscopic recognition of premalignant or cancerous lesions), patient history (family history of gastric cancer) and subsequent management (recommended H.pylorieradication and follow-up) data were collected.
Results
This retrospective cohort study conducted in a single academic centre identified 1842 patients who underwent diagnostic esophagogastroduodenoscopy with histological sampling between 2012 and 2020. Out of 1842 patients screened in the pathology database, 1762 had histologically proven premalignant gastric lesions (extensive gastric mucosal atrophy, intestinal metaplasia or both).
The study cohort consisted of 51% males with an average age of 64.42 (SD ±1.573). A positive family history of gastric cancer was reported in 0.7% of the patients.
Histological evaluation identified gastric atrophy in 9.9% (n = 183) of samples, distal atrophy in 6.1% (n = 113) of cases, and panatrophy in 3.8% (n = 70) of samples. Distal intestinal metaplasia was observed in 47.9% (n = 883) of cases, while extensive intestinal metaplasia was found in 47% (n = 866) of samples. Dysplasia was detected in 1.03% (n = 19) of the samples.
Endoscopically precancerous lesions were identified in only 14.4% (n = 254) of cases, with follow-up recommendations provided for 3.4% (n = 60) of the patients.
Helicobacter pylori presence on biopsy samples was detected in 37.6% (n = 662) of cases, with eradication recommended only for 36.7% (n = 243) of these cases.
Subsequently, during follow-up 0.8% (n = 14) of patients with premalignant gastric lesions were diagnosed with gastric cancer.
Conclusion
This study reveals poor efficacy of endoscopic evaluation for precancerous gastric lesions and suboptimal adherence to current guidelines for their management. These findings underpin the importance of high-quality endoscopy, dissemination and adherence to the guidelines in the hopes of reducing the morbidity and mortality of gastric cancer.
References
(1) Pimentel-Nunes P, Libânio D, Marcos-Pinto R, Areia M, Leja M, Esposito G, 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 (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019;51(4):365–88.
