Relative value of repeat gastric ulcer surveillance gastroscopy in diagnosing gastric cancer

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Abstract
Gastric cancer can present with the endoscopic appearances of a benign gastric ulcer (GU). Opinion remains divided on the need for follow-up of patients diagnosed with GU, and the aim of this study was to examine the long-term outcomes of patients whose GU proved malignant on follow-up gastroscopy. Between October 1, 1995, and September 30, 2003, 25 579 gastroscopies were performed in one unit. These identified 544 patients with apparently benign GU, of whom 277 (51%) underwent 334 elective follow-up endoscopies. Twelve of these patients (4.3%) were shown to have a malignant ulcer; their outcomes were compared to those of the 296 other patients diagnosed with gastric cancers in this time frame. The patients in the GU cancer group had earlier stage disease (stage I, 33% vs 6.4%; χ2 = 11.2; DF1; P = 0.001), and were more likely to undergo R0 gastrectomy (50% vs 30%; χ2 = 2.064; DF1; P = 0.151) and to survive long term (46% vs 16%; log-rank χ2, 5.79; DF1; P = 0.0162) than patients in the comparison cohort. Gastroscopic follow-up of 50 patients with an apparently benign GU will identify 1 patient with a malignancy destined to survive for 5 years following R0 gastrectomy. This justifies the diagnostic effort of repeat gastroscopy to ensure complete healing of GU.

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