recommendations for endoscopic and histological follow-up of patients with chronic gastritis and precancerous gastric lesions

Gastric cancer is the fourth most common cancer in the world and the second most common cause of cancer-related death. In the year 2009, 469 new cases of gastric cancer were found in Slovenia, 5-year survival rate was 24.5 %. Helicobacter pylori is a class I carcinogen and responsible for 60 %–80 % (by some authors up to 98 %) of all gastric cancers of intestinal and diffuse type, as well as gastric MALT lymphoma.

Gastric cancer incidence can be reduced by population-based screening for Helicobacter pylori infection before the age of 30 years. When after several decades of infection chronic multifocal atrophic gastritis with intestinal metaplasia develops in 8 % of infected persons, this is a point of no return. Eradication of infection at this stage cannot entirely prevent gastric cancer development. In those patients, serial biopsies according to Sydney protocol and risk stratification by means of the OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment ) staging system should be performed. Patients with OLGIM stage III and IV should be subject to surveillance endoscopies. The European Society of Gastrointestinal Endoscopy, the European Helicobacter Study Group and the European Society of Pathology have developed evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach. Patients with intestinal metaplasia in both corpus and antrum should undergo endoscopic and histological follow-up every three years. If low-grade dysplasia is present, controls should be performed every year. If high grade dysplasia is present, endoscopic and histologic follow-up should be performed every 6 months. All visible endoscopic lesions should be resected (endoscopically or surgically). Helicobacter pylori infection should be searched for with different diagnostic tests and all infected patients should be cured.

It is only by this approach that gastric cancer can be diagnosed at an early stage and five-year survival can be improved. These recommendations were accepted by the Slovenian Society for Gastroenterology and Hepatology, and the Slovenian Society for Pathology and Forensic Medicine.