Epidemiologic, clinicopathologic, and economic aspects of gastroscopic screening of patients with pernicious anemia.

In a well-defined population with a known prevalence of pernicious anemia (PA), gastroscopic screening was performed in 123 patients with PA, of whom 61 were rescreened after a mean time interval of 32 months. At the primary screening the prevalence of gastric neoplasia was 8.1% and that of gastric malignancy 4.1%. No neoplasias or malignancies were diagnosed at re-screening. The estimated cost per gastric neoplasia diagnosed during primary screening was USD 850 and that per diagnosed malignancy USD 1700. Adenoma, one with early adenocarcinoma, was diagnosed in two patients, primary early adenocarcinoma in two patients, and advanced adenocarcinoma in one patient. Five patients had gastric fundic mucosal carcinoid, of which one was multicentric with a regional metastasis. Gastric carcinoids most probably are underdiagnosed in atrophic gastritis, and, when small and solitary, their clinical relevance is uncertain. Fundic mucosal endocrine cell hyperplasia and hypergastrinemia seem to be important factors in their development.