First endoscopic surveillance for gastric neoplastic lesions 3 years after autoimmune or multifocal atrophic gastritis (AG) diagnosis appeared safe and should be offered to elderly patients (>70 years), who are at an increased risk for gastric neoplasia, according to study data published in Digestive and Liver Disease.
The longitudinal cohort study included 160 patients (median age, 66 years; 73.0% female) with a histological diagnosis of autoimmune or multifocal AG who underwent follow-up gastroscopy 3 years after receiving an AG diagnosis. Autoimmune AG was present in 122 patients (76.3%), and multifocal AG was present in 38 patients (23.7%). Twelve percent of patients received prior treatment for Helicobacter pylori infection; 5.6% of patient were found to have a first-degree family history of gastric cancer.
At the 3-year follow-up, 16 (10.0%) patients presented with 16 gastric neoplastic lesions. The malignancy types were as follows: 18.7%, gastric cancer; 25.0%, low-grade dysplasia; 12.5%, low-grade dysplasia adenoma; and 43.7%, type 1 neuroendocrine tumor.
In this group, Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia (OLGIM) III/IV stages were present in 4 (25.0%) patients and 1 (6.3%) patient, respectively. Eleven patients (69.0%) had autoimmune AG, and 15 (93.7%) had parietal cell antibodies positivity (P =.026 vs patients without lesions).
All patients with lesions were endoscopically (87.5%) or surgically (12.5%) “treated with favorable outcome,” according to the investigators. Notably, age greater than 70 years was associated with a 9-fold higher probability of developing gastric epithelial neoplastic lesions (odds ratio, 9.6; 95 CI% 1.2-79.4; P =.0359).
“Our findings show that the 3-year interval endoscopic surveillance in AG as proposed by European guidelines seems to be safe to accurately detect treatable gastric neoplastic lesions,” the study authors stated. “Interestingly, our study showed a high positivity of parietal cells antibodies in patients with neoplastic lesions and age [older than] 70 years as risk factor[s] to develop epithelial neoplastic lesions at the 3-year follow-up.”
The loss of 37.5% of patients at follow-up, which could have caused other cancers to be overlooked, constituted a study limitation. Further, three-quarters of the cohort had autoimmune AG; therefore, a subanalysis of multifocal and autoimmune AG could not be performed due to the low number of patients with multifocal AG.
“The first surveillance endoscopy 3 years after diagnosis seems safe for patients with autoimmune and multifocal AG,” the researchers said. They added that the detection of 3 gastric cancers at follow-up gastroscopy “raises the question” of whether an even shorter follow-up interval should be considered in certain patients. “Endoscopic surveillance is beneficial in patients with autoimmune AG and/or low-risk OLGA stages, and should be offered to elderly patients who are at highest risk for gastric neoplasia,” the study authors concluded.
Esposito G, Dilaghi E, Cazzato M, et al. Endoscopic surveillance at 3 years after diagnosis, according to European guidelines, seems safe in patients with atrophic gastritis in a low-risk region.Dig Liver Dis. Published online November 13, 2020. doi:10.1016/j.dld.2020.10.038