Endoscopy 2022; 54(09): 892-901
DOI: 10.1055/a-1724-7378
Systematic review

Risk factors for gastric metachronous lesions after endoscopic or surgical resection: a systematic review and meta-analysis

1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
,
Gonçalo Figueirôa
2   Surgery Department, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
,
3   Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
4   IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
Pedro Pimentel-Nunes
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
,
Cesare Hassan
6   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
7   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Mário Dinis-Ribeiro
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
,
3   Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
4   IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
,
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
5   CINTESIS (Center for Health Technology and Services Research), Faculty of Medicine, University of Porto, Porto, Portugal
› Author Affiliations

Abstract

Introduction Metachronous gastric lesions (MGL) are a significant concern after both endoscopic and surgical resection for early gastric cancer. Identification of risk factors for MGL could help to individualize surveillance schedules and potentially reduce the burden of care, but data are inconclusive. We aimed to identify risk factors for MGL and compare the incidence after endoscopic resection (ER) and subtotal gastrectomy.

Methods We conducted a systematic review by searching PubMed, ISI, and Scopus, and performed meta-analysis.

Results 52 studies were included. Pooled cumulative MGL incidence after ER was 9.3 % (95 % confidence interval [CI] 7.7 % to 11.0 %), significantly higher than after subtotal gastrectomy (1.2 %, 95 %CI 0.5 % to 2.2 %). After adjusting for mean follow-up, predicted MGL at 5 years was 9.5 % after ER and 0.7 % after subtotal gastrectomy. Older age (mean difference 1.08 years, 95 %CI 0.21 to 1.96), male sex (odds ratio [OR] 1.43, 95 %CI 1.22 to 1.66), family history of gastric cancer (OR 1.88, 95 %CI 1.03 to 3.41), synchronous lesions (OR 1.72, 95 %CI 1.30 to 2.28), severe gastric mucosal atrophy (OR 2.77, 95 %CI 1.22 to 6.29), intestinal metaplasia in corpus (OR 3.15, 95 %CI 1.67 to 5.96), persistent Helicobacter pylori infection (OR 2.08, 95 %CI 1.60 to 2.72), and lower pepsinogen I/II ratio (mean difference –0.54, 95 %CI –0.86 to –0.22) were significantly associated with MGL after ER. Index lesion characteristics were not significantly associated with MGL. ER treatment was possible in 83.2 % of 914 MGLs (95 %CI 72.2 to 91.9 %).

Conclusion Follow-up schedules should be different after ER and subtotal gastrectomy, and individualized further based on diverse risk factors.

Tables 1s–3s, Figs. 1s–4s



Publication History

Received: 21 June 2021

Accepted: 29 November 2021

Article published online:
01 February 2022

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