Giant gastric ulcers: Malignancy yield and predictors from a 10‐year retrospective single centre cohort

Abstract

Background and study aims: Gastric cancer is known to reside in some gastric ulcers but what predicts this association is still unclear. Historically it has been thought that the increasing size of gastric ulcers may be a predictor for harbouring malignancy. Giant gastric ulcers are arbitrarily defined as 3 cm. The aim of this retrospective study was to examine patients with giant gastric ulcers within a single tertiary centre over a 10-year period. Our primary outcomes included the malignancy yield in giant gastric ulcers and to determine if any demographic, clinical or endoscopic predictors for malignancy exist. Secondary outcomes included the 30-day and 12-month mortality. Method: Patients with giant gastric ulcers 3 cm presenting from September 2005 to December 2015 were included in the study. Malignancy yield was obtained by looking at histology reports. Predictors for malignancy were tested using binary logistic regression, after demographic, clinical and endoscopic variables were tested using univariate analysis and for collinearity. Results: A cohort of 111 patients was included for the final analysis. Forty-two giant gastric ulcers were malignant, equating to a yield of 37.8% (95% CI 28.8-46.8). Binary logistic regression revealed predictors for malignancy included: ulcer location being within the fundus, cardia or incisura (odds ratio (OR) 4.417; 95% CI 1.10-17.76; P ¼ 0.036); younger age of patient (OR 0.202; 95% CI 0.06-0.71; P ¼ 0.013); and endoscopic 'non-suspicion' (OR 0.138; 95% CI 0.049-0.39; P < 0.001). Patient's 12-month mortality for giant gastric ulcer was 61.9% (26/42) for malignant and 21.9% (11/73) for benign histology. Conclusion: We have shown a high malignancy yield of 37.8% (95% CI 28.8-46.8) and a 12-month mortality of 61.9% for malignant giant gastric ulcers and 21.9% for benign giant gastric ulcers. Predictors for malignancy in patients with giant gastric ulcers include ulcer location, patient's age and endoscopist's 'suspicion' during endoscopy.

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

“…Under endoscope or during surgery, a large or giant ulcer (defined as the largest dimension of ≥3 cm for gastric ulcers 5 and 2 cm for duodenal ulcer 6 ) was described in 25 patients; 7 – 31 A polypoid or pseudotumoral mass that protruded from the central area of the ulcer bed was mentioned frequently (in 11 cases 8 , 9 , 13 , 14 , 21 , 24 , 32 – 36 ). Five ulcers had an irregular margin.…”

Unusual Complicated Gastric Ulcers

“…We have found lesions where radiology examination was suggestive o a gastric diverticulum or a gastric fundus tumoral process (Figures 3 and 4). We hav found such ulcers after immunosuppressant therapies with mycophenolate-mofeti administered post-heart transplant [10][11][12][13][14].…”

Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults

“…These medications are known to have signifinicant adverse effects on the gastrointestinal, cardiovascular, hematologic, hepatic, immune, and renal systems; patients using these medications are therefore subject to various risk factors that may distinguish them from their nonuser counterparts (13,14). Because benign and malignant peptic ulcers can present different features (regular shape, even bases, and demarcated edges for benign ulcers versus irregular shape, uneven bases, and asymmetric edges for malignant ulcers) (15) and may lead to different mortality rates (21.9% for benign versus 61.9% for malignant ulcer) (16); therefore, patients with malignant ulcers, as identified from biopsy, were also excluded from subsequent analysis. Of the 1589 older patients meeting our inclusion criteria, 1196 provided informed consent after being briefed on the study purpose and confidentiality issues.…”