Class 16 Porto, 2008/2009 Professor Doutor Altamiro da Costa Pereira Authors: Ana Silva, Andreia Carvalho, Carlos Laranja, Cláudia Leite, Daniel Oliveira,

MANAGEMENT OF PREMALIGNANT LESIONS OF GASTRIC CANCER

A SURVEY OF EUROPEAN GASTROENTEROLOGISTS

Class 16

Porto, 2008/2009Professor Doutor Altamiro da Costa Pereira

Authors: Ana Silva, Andreia Carvalho, Carlos Laranja, Cláudia Leite, Daniel Oliveira, Francisco Silva, Henrique Sousa, Joana Matos, João Cardoso, Luís Vale, Mariana Santiago, Pedro Morais, Renato Ramos, Rui Loureiro, Tatiana Salazar;

Supervisors: Prof. Doutor Mário Ribeiro e Dr. Ricardo Santos

INTRODUCTION

RESEARCH QUESTION

PARTICIPANTSAND METHODS

Management of premalignant lesions of gastric cancer

RESULTS

REFERENCES

AIMS

DISCUSSION

Premalignant lesions

Gastric Cancer

High mortality and

morbidity

Lack of practical

recommendations

Worldwide incidence

INTRODUCTION


Premalignant lesions

Atrophic chronic gastritis (ACG)Intestinal metaplasia (IM)Dysplasia (Dys)


INTRODUCTION

Which are the main options concerning

diagnosis, monitoring and treatment of

premalignant lesions of gastric cancer

that are being taken by European

Gastroenterologists?


RESEARCH QUESTION


To assess the clinical practice in terms of diagnosis, monitoring and treatment of premalignant lesions of gastric cancer

To compile these management options into a database

AIMS


PARTICIPANTS AND METHODS

Type of study

Observational

Cross-sectional

Quantitative

Non-randomized sampling


Target Population: Gastroenterologists

performing research in this field

Articles search

Authors’ contacts database

Participants’ selection




Inclusion Criteria

European Author/Centre (when in doubt where included)

Published between 2007 – 2009Keywords: intestinal neoplasm,

precancerous conditions, adenocarcinoma, atrophic gastritis, metaplasia



Link sent by E-mail

Open-ended questionsClosed-ended questions

Data collection

Online Questionnaire

• Dependent variables:– Management options taken

• Independent variables:– Type of lesions– Author/Department– Place of work– Time of follow-up– How frequently techniques are applied– Diagnosis of H.P.– Eradication of H.P.



Variables description

RESULTS


Table1: E-mails response

E-mails sent

E-mails not

delivered

Researchers who couldn’t answer the

questionnaire

Responses to the

questionnaire

Response Rate

1st time

sent132 0 2 14 10,6%

2nd time

sent120 14 3 2 1,6%

16 12,2%


0 - Do your answers reflect your own practice or your department(s)?

My own Department0%

10%

20%

30%

40%

50%

60%

Frequency

RESULTS – Participants description

Graph1


RESULTS – Participants description

Public Private University Hospital Other0

2

4

6

8

10

12

14

Place of Work

Graph 2


RESULTS

42.9

57.1

Do you, in your everyday practice, use any protocol for the detection and management of patients with atrophic chronic gastritis (ACG),

intestinal metaplasia (IM) or dys-plasia (Dys)?

Yes

No

ACG IM Dys0

1

2

3

4

5

6

7

If yes, which case?

If yes, which case?

Graph 3

Graph 4


RESULTS

18.8

81.3

Does your hospital have any protocol for the detection and management of patients with

atrophic chronic gastritis (ACG), intestinal metaplasia (IM) or

dysplasia (Dys)?

Yes

No

ACG IM Dys0

0.5

1

1.5

2

2.5

3

3.5

If yes, which case?

Graph 5

Graph 6


RESULTS

Random Biopsies Random Biopsies in predefined cases

Targeted Biopsies Other0

1

2

3

4

5

6

7

Conserning biopsies, which is your usual procedure for the study of these

patients?

Graph 7

RESULTS


Low gradeHigh grade

ACGIM

Dys

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

61.5

91.7 100

91.7

38.5

8.38.3

H. Pylori Diagnosis

NoYes

Graph 8


RESULTS

Low gradeHigh grade

ACGIM

Dys

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15.416.7

46.2 5080 85.7

15.425

23.18.3

20 14.3

Sort of Follow-up

None

End. Follow-up asy.

End. Follow-up sym.

Other

Graph 9


RESULTS

Low gradeHigh grade

ACGIM

Dys

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

33.333.3

18.218.2

5050

16.716.7

27.3

54.5

54.5

9.1

18.2

Follow-up time for endoscopies when the patient is asymptomatic

48m

24m

12m

6m

3m

1m

Graph 10


RESULTS

Low gradeHigh grade

ACGIM

Dys

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

7590.9 100

100

259.1

Eradication of H. Pylori

NoYes

Graph 11

• Low response ratewe have 12.12% of response

• Not all questions were answered (missing)• Possible Selection Bias

- Only sent our questionnaire to practitioners who published papers


DISCUSSION

Problems and limitations

Low

sig

nifi

can

ce/p

reci

sio

n

Hard to make generalizations - Results don’t allow for guidelines to be created


DISCUSSION

Results of this study reflect some lack of consensus:

• disagreement about what is the best sort of follow-up for patients with IM or ACG

• techniques that should be used for the diagnosis of these lesions

However, some tendencies can be identified:

• diagnose H. pylori in patients with IM, ACG and Dys

• eradicate the bacteria when it is diagnosed

• for patients with dysplasia (both low and high grade) is to perform periodical endoscopies even if the patient is asymptomatic.


DISCUSSION


1. Contacts database

2. Answers to questionnaire 3. Management options database

4. Online publication - Build webpage- Software: MS Frontpage

RESULTS

[1] Lockead P, El-Omar EM. Gastric Cancer. Br Med Bull. 2008;85:87-100.[2] Parkin DM, Bray F, Ferlay J, Pisani P..Global cancer statistics, 2002. CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108.[3] Stomach (Gastric) Cancer [Internet]. Bethesda: National Cancer Institute. Estimated new cases and deaths from stomach cancer in the United States in 2008; [cited 2008 November 1]; [1 screen]. Available from: http://www.cancer.gov/cancertopics/types/stomach4] Plano Nacional de Prevenção e Controlo das Doenças Oncológicas 2007/2010, Dezembro 2007.[5] Sugiyama T, Asaka M. Helicobacter pylori infection and gastric cancer. Med Electron Microsc. 2004 Sep;37(3):149-57.[6] Menaker RJ, Sharaf AA, Jones NL. Helicobacter pylori infection and gastric cancer: host, bug, environment, or all three?. Curr Gastroenterol Rep. 2004 Dec;6(6):429-35.[7] de Vries AC, Haringsma J, Kuipers EJ. The detection, surveillance and treatment of premalignat gastric lesions related to Helicobacter pylori infection. Helicobacter 2007; 12: 1-15.[8] Bowles MJ, Benjamin IS. ABC of the upper gastrointestinal tract. Cancer of the stomach and pancreas. BMJ 2001;323:1413–6[9] Witold Bartnik. Clinical aspects of Helicobacter pylori infection. Pol Arch Med Wewn, 2008; 118 (7-8): 426-430 [10] M Dinis-Ribeiro, A Costa-Pereira, C Lopes, L Moreira-Dias. Guidelines for surveillance of patients with atrophic chronic gastritis and intestinal metaplasia in stomach would be welcome! Helicobacter . 2007 Feb;12(1):1-15


REFERENCES

http://www.ncbi.nlm.nih.gov/pubmed/15761078?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


ACKNOWLEDGEMENTS

Eng.º Jorge JácomeProf. Doutor Altamiro da Costa PereiraProf. Doutor Mário Dinis RibeiroDr. Ricardo Santos

Documents

Class 16 Porto, 2008/2009 Professor Doutor Altamiro da Costa Pereira Authors: Ana Silva, Andreia Carvalho, Carlos Laranja, Cláudia Leite, Daniel Oliveira,