scholarly journals Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP)

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324057
Author(s):  
Jonathan W J Lee ◽  
Feng Zhu ◽  
Supriya Srivastava ◽  
Stephen KK Tsao ◽  
Christopher Khor ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Significant Risk ◽  
Incidence Rates ◽  
Endoscopic Surveillance ◽  
Smoking History ◽  
Operating Characteristics ◽  
Gastric Intestinal Metaplasia ◽  
Risk Patients ◽  
Prospective Longitudinal

ObjectiveTo investigate the incidence of gastric cancer (GC) attributed to gastric intestinal metaplasia (IM), and validate the Operative Link on Gastric Intestinal Metaplasia (OLGIM) for targeted endoscopic surveillance in regions with low-intermediate incidence of GC.MethodsA prospective, longitudinal and multicentre study was carried out in Singapore. The study participants comprised 2980 patients undergoing screening gastroscopy with standardised gastric mucosal sampling, from January 2004 and December 2010, with scheduled surveillance endoscopies at year 3 and 5. Participants were also matched against the National Registry of Diseases Office for missed diagnoses of early gastric neoplasia (EGN).ResultsThere were 21 participants diagnosed with EGN. IM was a significant risk factor for EGN (adjusted-HR 5.36; 95% CI 1.51 to 19.0; p<0.01). The age-adjusted EGN incidence rates for patients with and without IM were 133.9 and 12.5 per 100 000 person-years. Participants with OLGIM stages III–IV were at greatest risk (adjusted-HR 20.7; 95% CI 5.04 to 85.6; p<0.01). More than half of the EGNs (n=4/7) attributed to baseline OLGIM III–IV developed within 2 years (range: 12.7–44.8 months). Serum trefoil factor 3 distinguishes (Area Under the Receiver Operating Characteristics 0.749) patients with OLGIM III–IV if they are negative for H. pylori. Participants with OLGIM II were also at significant risk of EGN (adjusted-HR 7.34; 95% CI 1.60 to 33.7; p=0.02). A significant smoking history further increases the risk of EGN among patients with OLGIM stages II–IV.ConclusionsWe suggest a risk-stratified approach and recommend that high-risk patients (OLGIM III–IV) have endoscopic surveillance in 2 years, intermediate-risk patients (OLGIM II) in 5 years.

Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions

Gut ◽  
2018 ◽  
Vol 68 (4) ◽  
pp. 585-593 ◽  
Author(s):  
Wouter J den Hollander ◽  
I Lisanne Holster ◽  
Caroline M den Hoed ◽  
Lisette G Capelle ◽  
Tjon J Tang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Diagnostic Yield ◽  
Endoscopic Surveillance ◽  
High Grade ◽  
Neoplastic Progression ◽  
Gastric Lesions ◽  
Gastric Intestinal Metaplasia ◽  
Improve Risk Stratification

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.

scholarly journals Improving the Diagnosis and Treatment of Early Gastric Cancer in the West

2021 ◽  
pp. 1-12
Author(s):  
Diogo Libânio ◽  
Raquel Ortigão ◽  
Pedro Pimentel-Nunes ◽  
Mário Dinis-Ribeiro
Keyword(s):  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Curative Resection ◽  
Narrow Band Imaging ◽  
Scoring Systems ◽  
Cost Effective ◽  
Endoscopic Surveillance ◽  
The West ◽  
Gastric Intestinal Metaplasia ◽  
Staging Systems

Gastric cancer is the third leading cause of cancer-related death. In Western countries, its lower prevalence and the absence of mass screening programmes contribute to late diagnosis and a slower implementation of minimally invasive treatments. A secondary prevention strategy through endoscopic surveillance of patients at high risk of intestinal-type gastric adenocarcinoma or by screening gastric cancer within colorectal screening programmes is cost-effective in intermediate-risk countries, though the identification of these patients remains challenging. Virtual chromoendoscopy with narrow-band imaging improves the accuracy of endoscopic diagnosis, significantly increasing the sensitivity for intestinal metaplasia while preserving specificity. Endoscopic grading of gastric intestinal metaplasia is feasible, correlates well with histological staging systems and also with gastric neoplasia risk and can be used to stratify risk. Endoscopic submucosal dissection (ESD) in the West achieves efficacy and safety outcomes similar to those reported for Eastern countries, and the long-term disease-specific survival is higher than 95%. A prospective comparative study with gastrectomy confirms its higher safety and its benefits concerning health-related quality of life. However, ESD is associated with a 5% risk of postprocedural bleeding and a 20% risk of non-curative resection. The knowledge of risk factors for adverse events and non-curative resection can improve patient selection. The risk of metachronous lesions after ESD is high (3–5% per year), and endoscopic surveillance is needed. The management of patients with non-curative resection can be optimized using risk scoring systems for lymph node metastasis.

Sa1672 A Family History of Gastric Cancer is Associated With the Presence of Gastric Intestinal Metaplasia in Patients Undergoing EGD With Biopsy

2012 ◽  
Vol 75 (4) ◽  
pp. AB240
Author(s):  
Justin M. Gomez ◽  
James T. Patrie ◽  
Jeanetta Frye ◽  
Bryan G. Sauer ◽  
Vanessa M. Shami ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Family History ◽  
Intestinal Metaplasia ◽  
Gastric Intestinal Metaplasia ◽  
History Of

scholarly journals Gastric Intestinal Metaplasia in an Underserved Population in the USA: Prevalence, Epidemiologic and Clinical Features

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Tarek Almouradi ◽  
Tadd Hiatt ◽  
Bashar Attar
Keyword(s):  
United States ◽  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Retrospective Review ◽  
The United States ◽  
Underserved Population ◽  
Limited Data ◽  
Gastric Intestinal Metaplasia ◽  
The Usa ◽  
Development Of Gastric Cancer

Gastric intestinal metaplasia is an important stage in the development of gastric cancer. Limited data is available regarding the prevalence of gastric intestinal metaplasia in the United States. We conducted a retrospective review of esophagogastroduodenoscopies performed in our endoscopy unit between the months of April and October 2010 to evaluate the prevalence and the epidemiologic and endoscopic features of gastric intestinal metaplasia in an underserved population in the United States.

scholarly journals Gastric Intestinal Metaplasia: Prevalence, Clinical Presentation, Endoscopic and Histological Features

2016 ◽  
Vol 62 (1) ◽  
pp. 56-59
Author(s):  
Silvia Cosmina Drasovean ◽  
Diana Elena Morărașu ◽  
Ofelia Daniela Pascarenco ◽  
Olga Brsunic ◽  
Danusia Maria Onișor ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peptic Ulcer ◽  
Intestinal Metaplasia ◽  
Clinical Presentation ◽  
Similar Distribution ◽  
Histological Findings ◽  
Erosive Gastritis ◽  
Histological Features ◽  
Gastric Intestinal Metaplasia ◽  
Endoscopic Findings

AbstractBackground and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pilory infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia. Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings. Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19). Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.

scholarly journals Microsatellite Instability in Gastric Intestinal Metaplasia in Patients with and without Gastric Cancer

2000 ◽  
Vol 156 (2) ◽  
pp. 537-543 ◽  
Author(s):  
Wai K. Leung ◽  
Jae J. Kim ◽  
Jong G. Kim ◽  
David Y. Graham ◽  
Antonia R. Sepulveda
Keyword(s):  
Gastric Cancer ◽  
Microsatellite Instability ◽  
Intestinal Metaplasia ◽  
Gastric Intestinal Metaplasia
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