Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions
| Autor: | W. Lesterhuis, Lisette G Capelle, Michael Doukas, Ernst J. Kuipers, Manon C.W. Spaander, Ingrid Prytz-Berset, Marco J. Bruno, Gijsbert den Hartog, Maikel P. Peppelenbosch, T Tang, Frank ter Borg, E. M. Witteman, Caroline M. den Hoed, Wouter den Hollander, Marie-Paule Anten, I. Lisanne Holster |
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| Přispěvatelé: | Gastroenterology & Hepatology |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Atrophic gastritis medicine.medical_treatment Gastroenterology Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Stomach Neoplasms Internal medicine Pepsinogen A Gastrins Gastroscopy medicine Biomarkers Tumor Humans Stage (cooking) Prospective cohort study Netherlands business.industry Norway Incidence (epidemiology) Incidence Intestinal metaplasia Cancer Middle Aged medicine.disease 030104 developmental biology Dysplasia Population Surveillance Disease Progression 030211 gastroenterology & hepatology Gastrectomy Female business Precancerous Conditions |
| Zdroj: | Gut, 68(4), 585-+. BMJ Publishing Group |
| ISSN: | 1468-3288 0017-5749 |
| Popis: | ObjectiveInternational guidelines recommend endoscopic surveillance of premalignant gastric lesions. However, the diagnostic yield and preventive effect require further study. We therefore aimed to assess the incidence of neoplastic progression and to assess the ability of various tests to identify patients most at risk for progression.DesignPatients from the Netherlands and Norway with a previous diagnosis of atrophic gastritis (AG), intestinal metaplasia (IM) or dysplasia were offered endoscopic surveillance. All histological specimens were assessed according to the updated Sydney classification and the operative link on gastric intestinal metaplasia (OLGIM) system. In addition, we measured serum pepsinogens (PG) and gastrin-17.Results279 (mean age 57.9 years, SD 11.4, male/female 137/142) patients were included and underwent at least one surveillance endoscopy during follow-up. The mean follow-up time was 57 months (SD 36). Four subjects (1.4%) were diagnosed with high-grade adenoma/dysplasia or invasive neoplasia (ie, gastric cancer) during follow-up. Two of these patients were successfully treated with endoscopic submucosal dissection, while the other two underwent a total gastrectomy. Compared with patients with extended AG/IM (PGI/II≤3 and/or OGLIM stage III–IV), patients with limited AG/IM (PG I/II>3 and OLGIM stage 0–II) did not develop high-grade adenoma/dysplasia or invasive neoplasia during follow-up (p=0.02).ConclusionIn a low gastric cancer incidence area, a surveillance programme can detect gastric cancer at an early curable stage with an overall risk of neoplastic progression of 0.3% per year. Use of serological markers in endoscopic surveillance programmes may improve risk stratification. |
| Databáze: | OpenAIRE |
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