Characteristics of gastric cancer in endoscopic screening with combined serum assay for anti-Helicobacter pylori antibody and pepsinogen levels

Abstract

 Objectives The purpose of this study was to clarify the clinicopathological characteristics of gastric cancer (GC) screened in the era of Helicobacter pylori (Hp) eradication. Screening programs should be designed with these characteristics in mind.
 Design The data from the endoscopic screening program for GC in Ota Memorial Hospital between June 2012 and July 2014 were reviewed in relation to the ABC method, Hp eradication history (Hp-er Hx), and endoscopic findings. Characteristics of GC cases detected in this program were analyzed retrospectively.
 Setting GC screening program with esophago-gastro-duodenoscopy (EGD) in one private screening center.
 Participants A total of 8,989 participants underwent a GC screening program with EGD. Of these, 8,242 individuals were screening using the ABC method. Excluding 115 post-gastrectomy cases, 8127 individuals participated in this study.
 Main outcome measures Individuals were classified using the ABC method, consistent with the recommendation used by the Japan Research Foundation of Prevention Diagnosis Therapy for Gastric Cancer. EGD was used to search neoplasms and inspect the underlined gastric mucosa for chronic atrophic gastritis (CAG), which was evaluated using the Kimura-Takemoto classification system.
 Results Sixteen cases of GC were detected. Although seven of these were in group A, there was a high probability of previous exposure to Hp because of Hp-er Hx or CAG. All GC cases were also diagnosed as CAG and most were open type. Each GC lesion was located in the atrophic gastric mucosa.
 Conclusions The prevalence of GC in each group in the ABC method has altered because of the recent development of Hp-er. Individuals with Hp-er Hx or CAG have a material risk of developing GC and certainly require periodic GC screening. Identification and inspection of atrophic gastric mucosae via EGD is crucial for early detection of GC.