6. Appropriateness of Gastroscopy: Risk Factors for Gastric Cancer [1]

Introduction

A large number of risk factors for the development of gastric adenocarcinomas have been studied, including dysplasia, gastric polyps, intestinal metaplasia, status post-gastrectomy, and pernicious anemia. The literature is difficult to evaluate since most published studies are retrospective and often deal with small patient numbers. This is one of the reasons why the need arose to supplement the literature with expert opinion on the subject.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article is divided into three parts: 1. A review of the literature related to risk factors for GI malignancies and the role of endoscopy in such situations. This review was made available to the panelists to support their assessment of appropriateness of use of UGE in patients with risk factors and pre-malignant conditions of the UGI tract; 2. An overview of the main panel results; 3. A summary of the published evidence and of the panel-based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)