Management of premalignant lesions of gastric cancer:

a survey of the main options applied by European Gastroenterologists

Introdução à Medicina - 2008/2009


AUTHORS: Silva AJ, Carvalho A, Laranja C A, Leite C, Oliveira D, Silva F, Sousa H, Matos J, Cardoso J, Vale L, Santiago M, Morais P, Ramos R, Loureiro R, Salazar T. Supervisors: Dinis-Ribeiro M, Santos R.

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BACKGROUND: Adequate management of patients with atrophic chronic gastritis (ACG), intestinal metaplasia (IM) or dysplasia may lead early diagnosis of patients with gastric cancer, with improvement in survival rates. However, till date, with the exception of H. pylori treatment, no guidelines exist for these patients’ management namely follow-up methods and schedule. 

AIM: To survey currently options taken by European Gastroenterologists for diagnosis, monitoring and treatment of premalignant lesions of gastric cancer.

METHODS: Between April and May 2009, European researchers publishing manuscripts during 2007 and 2008 under the subject of ‘pre-malignant gastric lesions’ were asked to answer to an on-line questionnaire (n=133).

RESULTS: Participants and existence of protocols. Twelve percent of answers were obtained. Less than half of participants (43%) use protocols for the detection and management of patients with ACG, IM or dysplasia. However, 82% mentioned this as a personal attitude and only 18% referred they act according to institutional protocols. Attitudes towards diagnosis: 50% use random biopsies in predefined sites in gastric mucosa. H. pylori diagnosis is seek and treated by 62% and 75% of participants in patients, respectively, if patients are found to have AGC. For over 90% of gastroenterologists, H. pylori diagnosis is made and treatment proposed if patients have IM (92%/91%) and dysplasia ( 92-100% /100%). Follow-up: Approximately half the participants propose endoscopic follow-up even if patients with ACG (46%) or IM (50%) are assymptomatic. However, to approximately 1/6 to ¼ of gastroenterologists, this should be done only if patients are symptomatic.  Participants tend to agree (80-85%), follow-up patients with dysplastic lesions. Also, 67% proposed a follow-up endoscopy after 24 to 48 months for those without dysplasia; but 82% perform endoscopic examinations to patients with dysplasia several times during first year of follow-up. Limitations: selection bias may have occurred but heterogeneity of practice observed should even be higher among general gastroenterologists. 

CONCLUSIONS: The results of this study reflect some lack of consensus among doctors. Most doctors will try to diagnose H. pylori in patients with IM, ACG and Dys. There is also a strong tendency to eradicate the bacteria when it is diagnosed specially in dysplasia. In terms of follow‑up, the most common option for patients is to perform endoscopies follow-up even if the patient is asymptomatic and it became more frequent when the lesion is worst like in both Low or High grade Dysplasia. However, there is some disagreement about what is the best sort of follow-up for patients with IM or ACG. Furthermore, a consensus among researchers about the frequency of endoscopies on asymptomatic patients does not exist but we state that the more serious the lesion is, the more periodic follow-up became.  There is also some disagreement on the techniques that should be used for the diagnosis of these lesions, especially on the subject of when chromoendoscopy should be performed and what kind of vital staining should be used.

KEY-WORDS: signs and symptoms, digestive, diagnostic techniques and procedures, therapy, stomach neoplasms 




Last Update: 10/06/2009