THE PREVALENCE OF GASTRIC NEOPLASIA IS INCREASED IN PATIENTS WITH CHRONIC LIVER DISEASE COMPARED TO A HEALTHY SCREENING POPULATION

Aims:

The standard paradigm of screening varices in patients with cirrhosis has for the greater part involved esophagogastroduodenoscopy (EGD). More recently, however, the Baveno VI criteria were proposed to identify patients who could safely avoid screening EGD. Epidemiological studies have suggested that patients with cirrhosis have an increased risk for gastric cancer.

We aimed to evaluate the prevalence of gastric neoplasia in cirrhotic patients who underwent screening EGD in a country with intermediate gastric cancer risk.

Methods:

This retrospective case-control study enrolled all asymptomatic cirrhotic patients who underwent EGD for varices screening from January 2008 to June 2018. Cases were matched with asymptomatic healthy individuals who underwent EGD for gastric cancer screening at the same time as colonoscopy performed for colorectal cancer screening.

Results:

We included 1974 subjects (610 patients, 1364 controls). Besides a male predominance in cases, no other demographic characteristic differed between groups. The leading aetiology of cirrhosis was alcoholic liver disease (53.3%) and chronic hepatitis C (16.2%). Of the 610 patients with cirrhosis, 13 (2.1%) had gastric neoplasia [gastric cancer, n = 10; high-grade dysplasia, n = 2; low-grade dysplasia, n = 1]. Most of the lesions (61.5%) were located in the gastric body, with a median size of 18 mm (15 – 24). Eight patients underwent surgical resection, 3 endoscopic resection (n = 2 ESD, n = 1 EMR) and 2 were referred for palliative care due to decompensated liver disease. Compared to controls, cirrhotic patients had a higher prevalence of gastric neoplasia [2.1% vs. 1%, p = 0.044; gastric cancer 1.6% vs. 0.8%, p = 0.08). The prevalence of Helicobacter pylori infection was lower in patients compared to controls (36.2% vs. 47.2%, p = 0.004).

Conclusions:

The prevalence of gastric neoplasia is significantly increased in patients with cirrhosis compared to healthy screening population. Despite growing evidence supporting the role of non-invasive methods to rule out varices, EGD should still be considered in cirrhotics, at least in those from countries with intermediate gastric cancer risk.