Nicolas Chapelle1,2,3, Matthieu Péron4,5,6, Jean-François Mosnier4,5,7, Lucille Quénéhervé4,5,6, Emmanuel Coron4,5,6, Alice Bourget4,5, Estelle Cauchin4, Yann Touchefeu4,6, Tamara Matysiak-Budnik4,5,6. 1. CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France, nicolas.chapelle@chu-nantes.fr. 2. Université de Nantes, Nantes, France, nicolas.chapelle@chu-nantes.fr. 3. INSERM, U1235, Nantes, France, nicolas.chapelle@chu-nantes.fr. 4. CHU de Nantes, Hôtel Dieu, Institut des Maladies de l'Appareil Digestif, Service d'Hépato-Gastroentérologie, Nantes, France. 5. Université de Nantes, Nantes, France. 6. INSERM, U1235, Nantes, France. 7. Service d'Anatomie Pathologique, CHU de Nantes, Nantes, France.
Abstract
INTRODUCTION: Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. DESIGN: All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). RESULTS: Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. CONCLUSION: In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.
INTRODUCTION: Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. DESIGN: All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). RESULTS: Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. CONCLUSION: In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.