Detection of Gastric Cancer by Repeat Endoscopy Within a Short Time after Negative Examination

Background and Study Aims: Although a large number of patients are examined using endoscopy in order to identify gastric cancer, it is unclear how individuals should be managed after they are not diagnosed as having gastric cancer at the time of their initial examinations. This study was conducted to identify the group at high risk for gastric cancer who should be examined by repeat endoscopy within a short time after obtaining negative results.

Patients and Methods: The study involved 3672 patients who were not diagnosed as having gastric cancer by endoscopy in 1993, but underwent re-examination by gastroscopy between January 1994 and December 1996.

Results: Among these participants, 32 patients (0.9 %) were diagnosed as having gastric cancer. The incidence of gastric cancer was 2.0 % in participants aged 60 to 69 and 2.7 % in those with marked atrophy of the gastric mucosa. Multivariate analysis showed that the odds ratios (OR) for patients aged 60 to 69 and those with marked atrophy of the gastric mucosa were 3.092 and 3.255 (P < 0.01), respectively. Gastric cancer was detected in 17.2 % of patients who were previously diagnosed as having gastric adenoma and in 2.2 % of those who were previously diagnosed as having gastric ulcer. The ORs for participants with these gastric lesions detected by the initial examination were 49.417 and 5.259 (P < 0.01), respectively.

Conclusions: Groups at high risk for gastric cancer were identified by the initial endoscopy, when two findings (gastric lesions, atrophy) and age were combined. We emphasize the importance of repeat endoscopic examination for patients who are aged 60 to 69 or have marked atrophy of gastric mucosa, even if no lesions are detected on initial endoscopy. If gastric adenoma or ulcer are detected, endoscopic examination should be likewise repeated or these lesions should be treated by endoscopy or by other means.

References

• 1 Muir C S, Harvey J C. Cancer of the stomach: overview. In: Sugimura T, Sasako M (eds). Gastric cancer. Oxford University Press, New York; 1997: 3-21
• 2 Koga M, Ikeda S, Iwasaki M, et al. Report of gastric mass survey in 1997.  J Gastroent Mass Surv. 2000;  38 163-181
• 3 Hosokawa O, Kaizaki Y, Nakaya T, et al. Retrospective study of endoscopic findings: 250 cases of gastric cancer.  Dig Endosc. 2000;  12 136-140
• 4 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis.  Endoscopy. 1969;  1 87-97
• 5 Kaneko E, Nakamura T, Umeda N, et al. Outcome of gastric carcinoma detected by mass survey in Japan.  Gut. 1977;  18 626-630
• 6 Fukao A, Tsubono Y, Tsuji I, et al. The evaluation of screening for gastric cancer in Miyagi Prefecture, Japan: a population-based case-control study.  Int J Cancer. 1995;  60 45-48
• 7 Kawai K, Watanabe Y. The impact of mass screening on gastric cancer mortality in Japan.  Gastrointest Endosc. 1998;  47 320-322
• 8 Miki K, Ichinose M, Yahagi N, et al. Efficiency of gastric cancer screening system using serum pepsinogen test. In: Siewer JR, Roder JD (eds). Progress in gastric cancer research.  Bologna; Monduzzi Editore 1997: 87-93
• 9 Hosokawa O, Tsuda S, Kidani E, et al. Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy.  Endoscopy. 1998;  30 669-674
• 10 Christie J, Shepherd N A, Codling B W, et al. Gastric cancer below the age of 55: implications for screening patients with uncomplicated dyspepsia.  Gut. 1997;  41 513-517
• 11 Fukao A, Hisamichi S, Ohsato N, et al. Correlation between the prevalence of gastritis and gastric cancer in Japan.  Cancer Causes Control. 1993;  4 17-20
• 12 Kaboto M, Imai H, Tsugane S, et al. Correlation between atrophic gastritis prevalence and gastric cancer mortality among middle-aged men in 5 areas in Japan.  J Epidemiol. 1993;  3 35-39
• 13 Dixon M F, Genta R M, Yardley J H, et al. Classification and grading of gastritis, the updated Sydney System.  Am J Surg Pathol. 1996;  20 1161-1181
• 14 Kitahara F, Kobayashi K, Sato T, et al. Accuracy of screening for gastric cancer using serum pepsinogen concentrations.  Gut. 1999;  44 693-697
• 15 Kimura K. Chronological transition of the fundic-pyloric border determined by stepwise biopsy of the lesser and greater curvatures of the stomach.  Gastroenterology. 1972;  63 584-692
• 16 Ito S, Murakita H, Hirai M, et al. Profile of Helicobacter pylori cytotoxin derived from two areas of Japan with different prevalence of atrophic gastritis.  Gut. 1996;  39 800-806
• 17 Satoh K, Kimura K, Taniguchi Y, et al. Biopsy sites suitable for the diagnosis of Helicobacter pylori infection and the assessment of the extent of atrophic gastritis.  Am J Gastroenterol. 1998;  93 569-573
• 18 Katoh M, Asaka M, Kudoh M, et al. Evaluation of endoscopic characteristics in a new gastritis classification system.  Dig Endosc. 1995;  7 363-371
• 19 Farinati F, Rugge M, Mario F D, et al. Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients.  Endoscopy. 1993;  25 261-264
• 20 Nimura H, Takayama S. Clinicopathological study of background gastric mucosa during long-term conservative maintenance therapy for intractable peptic ulcer.  J Gastroenterol. 1999;  34 18-27
• 21 Hansson L E, Nyren O, Hsing A W, et al. The risk of stomach cancer in patients with gastric or duodenal ulcer disease.  N Engl J Med. 1996;  335 242-249
• 22 Dolphin J A, Smith L A, Waugh J M. Multiple gastric ulcers: their occurrence in benign and malignant lesions.  Gastroenterology. 1953;  25 202-205
• 23 Stolte M. Clinical consequences of the endoscopic diagnosis of gastric polyp.  Endoscopy. 1995;  27 32-37