Seguimiento endoscópico de la úlcera gástrica en una población de riesgo intermedio de cáncer gástrico

Mañas, M. D.; Domper, Alejandra; Albillos, A.; Hernández, Arturo Vera; Carpintero, Pedro; Lorente, Rufo; López, B.; Santa, E. de la; Olmedo, José Ignacio Sánchez; Rodríguez, E. Alonso

doi:10.4321/s1130-01082009000500003

Rev. esp. enferm. dig.

2009

DOI: 10.4321/s1130-01082009000500003

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Seguimiento endoscópico de la úlcera gástrica en una población de riesgo intermedio de cáncer gástrico

M. D. Mañas

Alejandra Domper

A. Albillos

et al.

Abstract: Objectives: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. Patients and methods: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinica… Show more

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Cited by 6 publications

(3 citation statements)

References 8 publications

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“…The incidence of malignancy identified on follow-up endoscopy ranges from 0.8% to 5%. [3][4][5][6] In a single-center retrospective study over 6 years in the Netherlands, of the 321 gastric ulcers, 225 (70%) had a repeat gastroscopy, with only 5 (2%) malignancies detected at the repeat procedure. 7 In a multicenter retrospective study from the United Kingdom, 27 (6%) of 432 gastric ulcers were malignant.…”

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“…Size is also a risk factor, with a recent study showing 38% of patients with a large gastric ulcer ( > 3 cm) were diagnosed with gastric cancer during 12-month follow-up. 8 These endoscopic features in the absence of nonsteroidal anti-inflammatory use, 4,5 or in addition to other risk factors for gastric malignancy, may indicate a high risk ulcer. 9,10 We hypothesize that there is variation in practice with regards to ulcer biopsy, adherence to and timing of endoscopic follow-up.…”

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confidence: 99%

“…There are limited data validating the need for repeat gastroscopy in all patients with gastric ulcers and whether there are any endoscopic and clinical features that may stratify the need for follow-up. The incidence of malignancy identified on follow-up endoscopy ranges from 0.8% to 5% 3–6. In a single-center retrospective study over 6 years in the Netherlands, of the 321 gastric ulcers, 225 (70%) had a repeat gastroscopy, with only 5 (2%) malignancies detected at the repeat procedure 7.…”

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Evaluation of Endoscopic Practices and Outcomes in Follow-up of Gastric Ulcers

Yang

Hartley

Thompson

et al. 2021

Journal of Clinical Gastroenterology

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Goal: The aim of this study was to evaluate current practice in gastric ulcer follow-up to establish diagnostic yield and predictors of malignancy. Background: Repeat gastroscopy is routinely performed to confirm gastric ulcer healing and exclude malignancy. However, the incidence of malignancy at follow-up endoscopy is low, without consensus regarding case selection and timing. Study: New gastric ulcers diagnosed on gastroscopy at 2 institutions in Australia were identified through keyword search of endoscopy reports over a 5-year period (2013 to 2017). Data collected included patient demographics, clinical presentation, and endoscopic and histologic findings from initial and subsequent gastroscopies. Results: Of 795 patients, repeat gastroscopy was performed in 440 (55%). Malignancy was diagnosed in 52 (7%) with 83% identified at initial gastroscopy. Eight cancers were identified at repeat gastroscopy with malignancy yield of 2% (8/440). Three were diagnosed in patients with benign initial ulcer histology (3/286, 1%). One cancer was diagnosed during follow-up in a patient with benign histology but no repeat gastroscopy (1/286, 0.3%). Predictors of benign ulcers were absence of endoscopic suspicion [odds ratio (OR) 0.1 (0.03-0.13), P≤0.005], complete healing on repeat gastroscopy [OR 0.5 (0.34-0.70), P=0.036] and benign initial histology [OR 0.12 (0.43-0.90), P≤0.005]. Conclusions: Seven percent of new gastric ulcers were malignant with most identified with biopsy on initial gastroscopy. Malignancy yield from follow-up gastroscopy was 2%. Diagnostic yield of endoscopic follow-up may be low in ulcers with benign appearance and adequate histology. However, current practice of repeat gastroscopy is warranted in the absence of patient-based and lesion-based predictors of malignancy.

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confidence: 99%

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confidence: 99%

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Evaluation of Endoscopic Practices and Outcomes in Follow-up of Gastric Ulcers

Yang

Hartley

Thompson

et al. 2021

Journal of Clinical Gastroenterology

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Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy

Gielisse

Kuyvenhoven

2014

Gastric Cancer

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Objective To determine the diagnostic accuracy of endoscopic follow-up for gastric ulcers. Methods All cases of gastric ulcers diagnosed at our teaching hospital between September 2005 and November 2011 were reviewed. The cases were selected by using ENDOBASE, an endoscopy documentation system. The characteristics of the ulcers and their histology were analysed. Results During the study period 321 cases with a gastric ulcer were diagnosed, including 214 benign ulcers (67 %) and 107 malignant ulcers (33 %). The mean age of the population was 71 years. In 200 patients (62 %) the ulcers were classified as benign appearing at the first endoscopy. However, in five of these patients, the ulcers eventually were malignant. In all of these five patients the index gastroscopy revealed a non-benign histology. Therefore, the sensitivity of a benign appearance of the ulcer in combination with histology at the first endoscopy is 100 % to rule out malignancy. In 121 patients (38 %) the ulcers were explicitly labelled as potentially malignant in the report of the first endoscopy. Of these potentially malignant-appearing ulcers, 102 (84 %) were indeed malignant as confirmed by histology. The other 19 ulcers (16 %) were benign at follow-up. The sensitivity of the three potential malignant characteristics at endoscopy was: dirty base 79 %, elevated border 94 % and irregular border 91 %. The specificity was 93, 82 and 89 %, respectively. The median diameter of the ulcers was significantly higher in the malignant group compared to the benign ulcer group (p \ 0.0001). The accuracy of endoscopic malignancy diagnosis was as follows: sensitivity of 0.98 and specificity 0.84, positive predictive value 0.84 and negative predictive value 0.98. In total, 546 gastroscopies were performed in these 321 patients, of which 225 were follow-up endoscopies. By not monitoring ulcers considered benign in both appearance and histology, 173 gastroscopies would not have been performed, resulting in a decline of 77 % of the follow-up endoscopies performed. Conclusion Endoscopic follow-up of gastric ulcers considered benign by appearance and with benign histology showed no additive value in detecting unsuspected malignancy in this study. This strategy could reduce health costs and save distress to patients.

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Gastric ulcers: malignancy yield and risk stratification for follow-up endoscopy

et al. 2016

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Background and study aim: Malignant change can occur in gastric ulcer but guideline recommendations for follow-endoscopy (FU-OGD) are conflicting. This study aims to determine rate of malignancy and need for follow-up for gastric ulcers. Patients and methods: Patients with a first diagnosis of gastric ulcer between January 2012 and September 2013 were studied by analyzing endoscopic assessments, dysplasia, and malignancy yield and the influence of risk factors on the likelihood of benign disease. Results: In a cohort of 432 patients with gastric ulcer (53 % male, mean age 65 years) dysplasia or neoplasia were found in 27 (19 adenocarcinomas, 2 cases of dysplasia, 5 lymphomas, 1 melanoma; malignancy yield 6 %). Twenty-five (93 %) cases were diagnosed on first biopsy. The cancer yield of FU-OGD after initially benign biopsy was 0.9 %. Binary logistic regression analysis revealed that endoscopically benign appearance (odds ratio 0.004 95 % CI 0 – 0.576; P = 0.029), benign histology on first biopsy (odds ratio 0 95 % CI 0 – 0.39; P = 0.011) and lower number of ulcers (odds ratio 0.22 (95 % CI 0.05 – 0.99); P = 0.049) were independent predictors of benign disease. All dysplastic and neoplastic cases would have been identified by a combination of initial biopsies plus repeat endoscopy with further biopsies for endoscopically suspicious appearances. Conclusions: In this large cohort 6 % of gastric ulcers were found to be malignant, highlighting the need for all gastric ulcers to be biopsied. The cancer yield of FU-OGD after benign biopsies was low. We have demonstrated that the combination of benign index histology and no endoscopic suspicion of malignancy can predict benign disease. We recommend that all gastric ulcers to be biopsied. Risk stratification could potentially reduce need for FU-OGD.

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Seguimiento endoscópico de la úlcera gástrica en una población de riesgo intermedio de cáncer gástrico

Cited by 6 publications

References 8 publications

Evaluation of Endoscopic Practices and Outcomes in Follow-up of Gastric Ulcers

Evaluation of Endoscopic Practices and Outcomes in Follow-up of Gastric Ulcers

Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy

Gastric ulcers: malignancy yield and risk stratification for follow-up endoscopy

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