management of premalignant lesions of gastric cancer a survey of european gastroenterologists
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Management of premalignant lesions of gastric cancer A survey of European Gastroenterologists. Porto, 2008/2009. Professor Doutor Altamiro da Costa Pereira. Class 16. - PowerPoint PPT PresentationTRANSCRIPT
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
Management of premalignant lesions of gastric cancer
Premalignant lesions
Atrophic chronic gastritis (ACG)Intestinal metaplasia (IM)Dysplasia (Dys)
Management of premalignant lesions of gastric cancer
INTRODUCTION
Which are the main options concerning
diagnosis, monitoring and treatment of
premalignant lesions of gastric cancer
that are being taken by European
Gastroenterologists?
Management of premalignant lesions of gastric cancer
RESEARCH QUESTION
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
PARTICIPANTS AND METHODS
Type of study
Observational
Cross-sectional
Quantitative
Non-randomized sampling
Management of premalignant lesions of gastric cancer
Target Population: Gastroenterologists
performing research in this field
Articles search
Authors’ contacts database
Participants’ selection
PARTICIPANTS AND METHODS
Management of premalignant lesions of gastric cancer
PARTICIPANTS AND METHODS
Inclusion Criteria
European Author/Centre (when in doubt where included)
Published between 2007 – 2009Keywords: intestinal neoplasm,
precancerous conditions, adenocarcinoma, atrophic gastritis, metaplasia
Management of premalignant lesions of gastric cancer
PARTICIPANTS AND METHODS
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.
Management of premalignant lesions of gastric cancer
PARTICIPANTS AND METHODS
Variables description
RESULTS
Management of premalignant lesions of gastric cancer
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%
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
RESULTS – Participants description
Public Private University Hospital Other0
2
4
6
8
10
12
14
Place of Work
Graph 2
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
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.
Management of premalignant lesions of gastric cancer
DISCUSSION
Management of premalignant lesions of gastric cancer
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
Management of premalignant lesions of gastric cancer
REFERENCES
Management of premalignant lesions of gastric cancer
ACKNOWLEDGEMENTS
Eng.º Jorge JácomeProf. Doutor Altamiro da Costa PereiraProf. Doutor Mário Dinis RibeiroDr. Ricardo Santos