First Surveillance Endoscopy Three Years After Atrophic Gastritis Diagnosis Appears Safe

Investigators of the longitudinal cohort study evaluated follow-up gastroscopy results from patients who underwent surveillance 3 years after receiving a diagnosis of autoimmune or multifocal atrophic gastritis.

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.

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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