Accuracy of upper endoscopies with random biopsies to identify patients with gastric premalignant lesions who can safely be exempt from surveillance

Michiel C. Mommersteeg, Stella A.V. Nieuwenburg, Wouter J. den Hollander, Lisanne Holster, Caroline M. den Hoed, Lisette G. Capelle, Tjon J. Tang, Marie Paule Anten, Ingrid Prytz-Berset, Ellen M. Witteman, Frank ter Borg, Jordy P.W. Burger, Michail Doukas, Marco J. Bruno, Maikel P. Peppelenbosch, Gwenny M. Fuhler, Ernst J. Kuipers, Manon C.W. Spaander*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: Guidelines recommend endoscopy with biopsies to stratify patients with gastric premalignant lesions (GPL) to high and low progression risk. High-risk patients are recommended to undergo surveillance. We aimed to assess the accuracy of guideline recommendations to identify low-risk patients, who can safely be discharged from surveillance. Methods: This study includes patients with GPL. Patients underwent at least two endoscopies with an interval of 1–6 years. Patients were defined ‘low risk’ if they fulfilled requirements for discharge, and ‘high risk’ if they fulfilled requirements for surveillance, according to European guidelines (MAPS-2012, updated MAPS-2019, BSG). Patients defined ‘low risk’ with progression of disease during follow-up (FU) were considered ‘misclassified’ as low risk. Results: 334 patients (median age 60 years IQR11; 48.7% male) were included and followed for a median of 48 months. At baseline, 181/334 (54%) patients were defined low risk. Of these, 32.6% were ‘misclassified’, showing progression of disease during FU. If MAPS-2019 were followed, 169/334 (51%) patients were defined low risk, of which 32.5% were ‘misclassified’. If BSG were followed, 174/334 (51%) patients were defined low risk, of which 32.2% were ‘misclassified’. Seven patients developed gastric cancer (GC) or dysplasia, four patients were ‘misclassified’ based on MAPS-2012 and three on MAPS-2019 and BSG. By performing one additional endoscopy 72.9% (95% CI 62.4–83.3) of high-risk patients and all patients who developed GC or dysplasia were identified. Conclusion: One-third of patients that would have been discharged from GC surveillance, appeared to be ‘misclassified’ as low risk. One additional endoscopy will reduce this risk by 70%.

Original languageEnglish
Pages (from-to)680-690
Number of pages11
JournalGastric Cancer
Volume24
Issue number3
Early online date22 Feb 2021
DOIs
Publication statusPublished - 2021

Bibliographical note

Funding Information:
This study has been supported by the UEG research price.

Publisher Copyright: © 2021, The Author(s).

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