CLINICAL CHARACTERISTICS AND MANAGEMENT OF PATIENTS WITH GASTRIC PRECANCEROUS LESIONS (GPL) IN FRANCE: A LARGE 15-YEARS SINGLE CENTER RETROSPECTIVE STUDY

Aims:

Our aim was to analyse, in a large retrospective study, the frequency, clinical characteristics, evolution, and modalities of surveillance of GPL in France.

Methods:

We analyzed the data of every patients having undergone an endoscopy with gastric biopsies between 2000 and 2015 in one academic center, and in whom a GPL [atrophic gastritis (AG), or intestinal metaplasia (IM), or dysplasia (D)] was diagnosed histologically, through in the pathology database.

Results:

From the 16764 patients having undergone an upper endoscopy with gastric biopsies, 531 patients (median age 70 years, 59% of men) with GPL were identified (detection rate 3.2%). The commonest indications for endoscopy were anaemia (31%), “control” (26%), abdominal pain (16%). At initial endoscopy, 12 patients (2%) had AG, 402 (79%) IM, 84 (17%) low grade dysplasia (LGD), 11 (2%) high grade dysplasia (HGD), 22 patients with both GPL and adenocarcinoma were excluded. H. pylori was found in 202 patients (41%). The mucosa was described as “normal” in 19% of cases. The GPL were confined in the Antrum in 64% of the cases. The median age at diagnosis increased significantly with the worsening of the lesion 57, 69, 71 and 77 years in patients with AG, IM, LGD and HGD respectively (p = 0.008).

Only 258 patients (50%) had at least one follow-up endoscopy (median: 1) The median delay between two endoscopies during the follow up was 8.3 months (min 0, max 113). During a median follow-up of 39.9 months (min 0.3 – max 137 months), a worsening of the GPL was found in 40 patients (9 adenocarcinoma), a regression in 146 patients (29%).

Conclusions:

This study showed that in France: 1/There was a significant increase in age with the worsening of the lesion 2/A progression and a regression of the GPL was found in 7% and 29% of patients, respectively.