Not every stomach is the same: tailoring dysplastic and early gastric cancer lesions detection

Aims Early detection of gastric dysplastic lesions and early gastric cancer (EGC) is crucial to enable prompt treatments, such as endoscopic submucosal dissection (ESD). Understanding the distribution and characteristics of these lesions can enhance the efficiency of screening and surveillance endoscopic examinations. This study aimed to analyze the locations and characteristics of dysplasia and EGCs in the stomach.

Methods Retrospective study reviewing pathologically diagnosed gastric dysplasia and EGCs treated by ESD. Lesions were grouped by location (proximal – fundus and body; distal – incisura and antrum) and compared regarding several clinicopathological variables.

Results A total of 215 patients were included, mostly males (66.5%) with a mean age of 68±8 years. We analyzed 225 lesions: 114 (50.7%) with low-grade dysplasia, 69 (30.7%) with high-grade dysplasia, and 42 (18.7%) with adenocarcinoma. Lesions were most frequently located in the smaller curvature (39.6%) and the distal parts of the stomach (71.1%). EGCs were predominantly found in the distal parts of the stomach (71.4%). Within the distal parts, EGCs were mainly located the smaller curvature (46.7%), while in proximal ECGs, the posterior wall (41.7%) was the most frequent site. Lesions in the distal parts of the stomach were significantly associated with older age (p=0.027). In the proximal parts of the stomach, lesions were more often linked to tobacco smoking (p=0.008), excessive alcohol consumption (p=0.003), and male sex (p=0.001).

Conclusions Most gastric dysplastic lesions and EGCs were located in the distal parts and smaller curvature of the stomach. Proximal lesions were more frequently identified in smokers, excessive alcohol consumers and male sex. These location-specific characteristics can enhance the diagnostic performance of endoscopic screening and surveillance, potentially leading to improved patient outcomes.