Introduction
The cumulative lifetime risk of gastric cancer (GC) in patients with Lynch syndrome (LS) is reported to be 8%. There is limited evidence on specific risk factors for GC and no agreement among guidelines on gastric endoscopic surveillance schedule in LS patients.
Aims and methods
We conducted a retrospective cohort study to identify risk factors for gastric precancerous conditions (chronic atrophic gastritis and intestinal metaplasia) and GC in patients with LS and a case–control study to compare the prevalence of these conditions with a control group.
Results
We included 385 LS patients (40.5% male, mean age 49.0 years). During a median follow-up period of 48 months (interquartile range, 24–84 months), precancerous conditions were identified in 110 patients (34%) and the prevalence of advanced stages of atrophic gastritis was 3% for OLGA III/IV and 0.6% OLGIM III/IV. Family history of GC was significantly associated with OLGA III/IV (P = 0.020). Among LS patients, 10 patients (2.6%) were diagnosed with GC (incidence rate of 5/1000 persons-year). Older age and OLGA III/IV were identified as risk factors for GC (P < 0.001). When compared with controls, patients with LS had significantly higher rates of Hp infection (P = 0.035) and lower OLGA and OLGIM stages (P < 0.001 and P = 0.026, respectively).
Conclusion
In our cohort, the incidence of GC and advanced stages of atrophic gastritis was low. Older age and OLGA III/IV were associated with a higher risk of GC. Identification of risk factors for GC in LS patients can help tailoring endoscopic surveillance.
<b><i>Background and Aims:</i></b> Laparoscopic and endoscopic cooperative surgery (LECS) combines advantages of endoscopy and laparoscopy in order to resect upper gastrointestinal lesions. Our aim was to evaluate the efficacy and safety of LECS in patients with EGJ (esophagogastric junction), gastric and duodenal lesions, as well as to compare LECS with pure endoscopic and pure laparoscopic procedures. <b><i>Methods:</i></b> PubMed, Scopus, and ISI Web of Knowledge were searched. Efficacy (R0, recurrence) and safety (conversion rate, procedure and hospitalization time, adverse events, mortality) outcomes were extracted and pooled (odds ratio or mean difference) using a random-effects model. Study quality was assessed with Newcastle-Ottawa Scale and heterogeneity by Cochran’s Q test and I<sup>2</sup> . Subgroup analysis according to location was performed. <b><i>Results:</i></b> This meta-analysis included 24 studies/1,336 patients (all retrospective cohorts). No significant differences were found between LECS and preexisting techniques (endoscopic submucosal dissection (ESD)/laparoscopy) regarding any outcomes. However, there was a trend to shorter hospitalization time, longer procedure duration, and fewer adverse events in LECS versus Laparoscopy and ESD. R0 tended to be higher in the LECS group. Hospitalization time was significantly shorter in gastric versus EGJ lesions (mean 7.3 vs. 13.7 days, 95% CI: 6.6–7.9 vs. 8.9–19.3). There were no significant differences in conversion rate, adverse events, or mean procedural time according to location. There was a trend to higher conversion rate and longer procedure durations in EGJ and higher rate of adverse events in duodenal lesions. <b><i>Conclusion:</i></b> LECS is a valid, safe, and effective treatment option in patients with EGJ, gastric, and duodenal lesions, although existing studies are retrospective and prone to selection bias. Prospective studies are needed to assess if LECS is superior to established techniques. <b><i>Key Messages:</i></b> LECS is safe and effective in the treatment of upper gastrointestinal lesions, but there is no evidence of superiority over established techniques.
Carriers of the mutated CDH1 gene have an increased risk of developing early-onset signet-ring cell (diffuse) gastric cancer. We present a case of a young patient with a confirmed mutation of the CDH1 gene, who was diagnosed with a gastric marginal zone B-cell lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT lymphoma) from surveillance endoscopy. He underwent Helicobacter pylori eradication treatment and was subsequently submitted to a total prophylactic gastrectomy. The surgical specimen only revealed foci of signet-ring cell carcinoma (SRCC) in situ without lymphoma signs. We highlight here the occurrence of other pathology in high-risk patients as well as its possible influence on the decision to perform gastrectomy.
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