Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis

Raquel Ortigão; Gonçalo Figueirôa; Leonardo Frazzoni; Pedro Pimentel-Nunes; Cesare Hassan; Mário Dinis-Ribeiro; Lorenzo Fuccio; Diogo Libânio

doi:10.1055/a-1724-7378

Endoscopy, Table of Contents

Endoscopy 2022; 54(09): 892-901
DOI: 10.1055/a-1724-7378

Systematic review

Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis

Raquel Ortigão

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

,

Gonçalo Figueirôa

²Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal

,

Leonardo Frazzoni

³Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

⁴IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Pedro Pimentel-Nunes

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

⁵CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal

,

Cesare Hassan

⁶Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

⁷Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy

,

Mário Dinis-Ribeiro

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

⁵CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal

,

Lorenzo Fuccio

³Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

⁴IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

,

Diogo Libânio

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

⁵CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal

› Author Affiliations

Abstract

Introduction Metachronous gastric lesions (MGL) are a significant concern after both endoscopic and surgical resection for early gastric cancer. Identification of risk factors for MGL could help to individualize surveillance schedules and potentially reduce the burden of care, but data are inconclusive. We aimed to identify risk factors for MGL and compare the incidence after endoscopic resection (ER) and subtotal gastrectomy.

Methods We conducted a systematic review by searching PubMed, ISI, and Scopus, and performed meta-analysis.

Results 52 studies were included. Pooled cumulative MGL incidence after ER was 9.3 % (95 % confidence interval [CI] 7.7 % to 11.0 %), significantly higher than after subtotal gastrectomy (1.2 %, 95 %CI 0.5 % to 2.2 %). After adjusting for mean follow-up, predicted MGL at 5 years was 9.5 % after ER and 0.7 % after subtotal gastrectomy. Older age (mean difference 1.08 years, 95 %CI 0.21 to 1.96), male sex (odds ratio [OR] 1.43, 95 %CI 1.22 to 1.66), family history of gastric cancer (OR 1.88, 95 %CI 1.03 to 3.41), synchronous lesions (OR 1.72, 95 %CI 1.30 to 2.28), severe gastric mucosal atrophy (OR 2.77, 95 %CI 1.22 to 6.29), intestinal metaplasia in corpus (OR 3.15, 95 %CI 1.67 to 5.96), persistent Helicobacter pylori infection (OR 2.08, 95 %CI 1.60 to 2.72), and lower pepsinogen I/II ratio (mean difference –0.54, 95 %CI –0.86 to –0.22) were significantly associated with MGL after ER. Index lesion characteristics were not significantly associated with MGL. ER treatment was possible in 83.2 % of 914 MGLs (95 %CI 72.2 to 91.9 %).

Conclusion Follow-up schedules should be different after ER and subtotal gastrectomy, and individualized further based on diverse risk factors.

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