Gastric cancer and dysplasia in early-stage chronic atrophic gastritis: time for gastric cancer screening in high-risk areas?

Aims A recognized independent risk factor for the development of gastric cancer is the presence of moderate-to-severe chronic atrophic gastritis (OLGA stage III-IV)[1] [2]. In Italy, the Po Valley area, encompassing the provinces of Cremona and Mantua, is considered a high-risk region, with a standardized incidence rate of 32.2 cases per 100,000 for men and 15.9 cases per 100,000 for women3. The present single-center retrospective observational study aims to evaluate, over a period of approximately 10 years, the incidence of dysplastic and neoplastic lesions amenable to endoscopic resection and its correlation with OLGA staging and other recognized risk factors in this high-risk population.

Methods We retrospectively analyzed all mucosal resections (EMR), submucosal dissections (ESD), and hybrid resections (Hybrid EMR/ESD) performed at our hospital between december 2014 and september 2024 for visible gastric lesions identified as low-grade dysplasia (LGD) or high-grade dysplasia (HGD) in pre-resection biopsies. For each patient, we collected demographic data, information on risk factors for gastric neoplasia, pre- and post-resection histology, and details related to the endoscopic resection procedure. The five biopsies for OLGA staging were performed concurrently with biopsy sampling of visible lesions, and all specimens underwent also to a second-look pathological examination.

Results A total of 66 patients (M/F 35/31; mean age: 74.9 years) were included in the study. Pre-resection biopsies revealed LGD in 64% of cases and HGD in the remaining 36%. Examination of the resected specimens identified 29 lesions as LGD (44%), 16 as HGD (24%), 3 as intramucosal adenocarcinomas (5%), 14 as pT1a adenocarcinomas (21%), and 4 as pT1b adenocarcinomas (6%). Regarding risk factors: 9 patients (14%) had a first-degree family history of gastric neoplasia, while 16 patients (24%) were affected by Helicobacter pylori at the time the lesion was identified. The more interesting finding comes from the pre-resection OLGA staging: 4 patients had no gastric mucosal atrophy (OLGA 0), and 34 patients had early-stage chronic atrophic gastritis (15 OLGA I and 19 OLGA II). Among the remaining patients, 24 presented with OLGA stage III, and 4 with OLGA stage IV.

Conclusions Our experience shows that traditional risk factors for gastric neoplasia are insufficient in high-risk areas to identify the population that might benefit from short-term endoscopic follow-up. These data further support the statement recently included in the upcoming ESGE guidelines Update on the management of precancerous conditions of the stomach (draft), highlighting the need for periodic screening in high-risk populations regardless of additional risk factors [3].

Publication History

Article published online:
27 March 2025

• References

• 1 Dinis-Ribeiro M. et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacterand Microbiota Study Group (EHMSG), European Society of Pathology (ESP) guidelina Update. 2025; 11.13.2024 (Draft)..
• 2 Val Padana Cancer Registry, ATS (Health Protection Agency) Val Padana https://www.ats-valpadana.it/documents/1654672/64558781/Stomaco.pdf/3a88e15f-a32e-9344-a748-fdfa71f138ea
• 3 Na YS, Kim SG, Cho SJ.. Risk assessment of metachronous gastric cancer development using OLGA and OLGIM systems after endoscopic submucosal dissection for early gastric cancer: a long-term follow-up study. Gastric Cancer 2023; 26 (02): 298-306