774 ENDOSCOPIC SURVEILLANCE INTERVAL MORE THAN 12 MONTHS IS A RISK OF GASTRIC CANCER WITH NON-CURATIVE ENDOSCOPIC RESECTION

Abstract

Surveillance endoscopy must be performed for patients with a high risk of developing gastric cancer (GC). According to the 5th edition of the Japanese gastric cancer treatment guidelines (JGC-GL), they recommend performing surveillance endoscopy annually or twice a year for high risk patients. The aims of this study were to evaluate the usefulness of surveillance endoscopy for the detection of early-stage gastric cancer and to verify the surveillance intervals of annual or twice a year. We retrospectively analyzed the data of 177 gastric cancer patients who previously underwent surveillance endoscopy at least two times at our hospital from January 2014 to December 2018. The average age of patient were 73.2 (26—93) years. The number of male and female was 131 and 46, respectively. The rate of severe atrophy was 88.0% (147/167). There were 5 uninfected, 34 current, and 132 past infection of Helicobacter pylori, respectively. There were 102 patients with a history of endoscopic resection (ER). The median size of GCs was 9.5 mm. There were 164 differentiated and 13 undifferentiated GCs, 161 mucosal, 14 submucosal, and 2 muscularis propria, respectively. 174 and 3 GCs were resected by ER and surgical resection, respectively. Among the ER cases, 160 were curative ER and 14 were non-curative ER cases due to submucosal invasion, lymph-vascular invasion, or positive margin. Among non-curative ER cases, 8 underwent additional surgical resection, and lymph node metastasis was found in 1 case (12.5%). The median endoscopic surveillance interval from the last endoscopy to the detection of gastric cancer in the curative ER cases was 12 months (5—177). The median interval in the non-curative ER cases and surgical resection cases with non-indication of ER was 14 months (10—63). The rate of patients who had endoscopic surveillance interval more than 12 months were significantly higher in the non-curative ER cases and surgical cases than those in curative ER cases (p=0.0029). Endoscopic surveillance interval more than 12 months identified as a risk factor in multivariate analysis (p=0.0174). Surveillance endoscopy should be performed within12 months to detect gastric cancer with curative ER. A multi-institutional prospective study is necessary to investigate the appropriate interval of surveillance endoscopy.