Endoscopy 2020; 52(S 01): S129
DOI: 10.1055/s-0040-1704397
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GASTRIC CANCER OCCURS AT 3-YEARS ENDOSCOPIC SURVEILLANCE IN LOW RISK ATROPHIC GASTRITIS PATIENTS

G Esposito
1   Sapienza University, Department of Medical-Surgical Sciences and Translational Medicine, Rome, Italy
,
M Cazzato
1   Sapienza University, Department of Medical-Surgical Sciences and Translational Medicine, Rome, Italy
,
F Falangone
1   Sapienza University, Department of Medical-Surgical Sciences and Translational Medicine, Rome, Italy
,
E Di Giulio
1   Sapienza University, Department of Medical-Surgical Sciences and Translational Medicine, Rome, Italy
,
E Pilozzi
2   Sapienza University, Department of Pathology, Rome, Italy
,
B Annibale
1   Sapienza University, Department of Medical-Surgical Sciences and Translational Medicine, Rome, Italy
,
E Lahner
1   Sapienza University, Department of Medical-Surgical Sciences and Translational Medicine, Rome, Italy
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Publikationsdatum:
23. April 2020 (online)

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    Aims Atrophic gastritis (AG) or intestinal metaplasia (IM) are at risk for development of pre- and neoplastic lesions. MAPS II guidelines recommend for patients with advanced stage of AG/IM, surveillance with high quality endoscopy every 3 years.

    This study aimed to assess the occurrence of pre- and neoplastic lesions in AG patients at 3-years follow-up.

    Methods Prospective study (2011-2019) on consecutive patients with histological diagnosis of AG/IM who performed follow-up at 3 years interval (±6 months) were included. Exclusion criteria were: follow-up and/or polypectomy/intervention < 3 years. Gastroscopy was first evaluated in high resolution white light endoscopy and then by Narrow Band Imaging (NBI). Histological examination was performed according to Updated Sydney System with neoplastic risk stratification by OLGA/OLGIM (operative link on gastric atrophy/metaplasia) scores.

    Results Overall 128 patients (73% female, median age 63 yrs (31-83)) were included. Median follow-up was 36 (30-42) months. At baseline, endoscopically visible elevated lesions were observed and removed in 10 (7.8%) patients: low grade dysplasia (LGD) adenoma in 1 patient (0.8%), type-1 gastric carcinoid (T1-GC) in 3 (2.3%) patients and hyperplastic polyps in 6 (4.7%) patients.

    At 3-years follow-up, 16 (12.5%) patients presented 16 (12.5%) lesions, 14 endoscopically visible and 2 intramucosal. Endoscopically visible lesions were 3 (2.3%) GC, 3 (2.3%) T1-GC, 1 (0.8%) LGD adenoma and 7 (5.5%) hyperplastic polyps. Intramucosal lesions were 2 (1.6%) LGD. GC was diagnosed at 31/36/32 months after previous upper endoscopy and the 3 patients with GC neither presented advanced stages of OLGA/OLGIM scores nor first-degree familiarity for GC nor H. pylori infection. They are alive and they were treated by endoscopic (1 patient) and surgical treatment (2 patients).

    Conclusions The 3-years endoscopic surveillance seems satisfactory to timely detect gastric neoplastic lesions. However, 2 patients needed a surgical treatment. Likely, current criteria for early detection of neoplastic lesions should be better addressed.


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