Risk Factors for Metachronous Lesions After Gastric Endoscopic or Surgical Resection - A Systematic Review And Meta-Analysis

Aims Metachronous gastric lesions (MGL) is a major concern after curative resection of early gastric cancer (EGC) by endoscopic resection (ER) or partial gastrectomy (PG), and endoscopic surveillance is needed after treatment. Risk factors for its development could help in individualizing surveillance schedule, but are controversial in literature. Our aim was to identify significant risk factors for MGL and compare the incidence of MGC after ER and PG.

Methods Three online databases (MEDLINE, ISI and Scopus) were searched up to May/2020. Data was analysed using random effects model and summarized as pooled odds ratio (OR) (for categorical variables) and mean differences (for continuous variables) with 95 % confidence interval (CI). Heterogeneity was assessed by I².

Results Forty-seven studies were included (median follow-up of 37.0 months after ER and 77.5 months after PG). The pooled MGL rate after ER was 9.0 % (95 % CI 7.4-10.7 %), significantly higher than after PG (1.4, 95 % CI 0.6-2.6 %), although there was significant heterogeneity across studies. Older age (mean difference 0.79 years, 95 % CI 0.17-1.42), male sex (OR = 1.34, 95 % CI 1.17-1.54), family history of gastric cancer (OR = 1.88, 95 % CI 1.03-3.41), presence of synchronous lesions (OR = 1.48, 95 % CI 1.21-1.80), intestinal metaplasia in corpus (OR = 3.15, 1.67-5.96) and low pepsinogen I/II ratio (mean difference -0.54, 95 % CI -0.86, -0.22) were significantly associated with MGL after ER. Lesion characteristics as size, morphology, location and lesion histology were not significantly associated with MGL. Persistent H. pylori infection was also associated with a higher risk of MGL (OR 1.86, 95 % CI 1.40-2.46). Regarding patients who underwent PG, male sex was the only significant risk factor for MGL (OR = 4.53, 95 % CI 1.77-11.61).

Conclusions Patients submitted to PG require less intensive follow-up than those submitted to ER. Several risk factors were associated with MGL which can possibly guide the surveillance schedule according to the individual risk.

Citation: Ortigão R, Figueirôa G, Pimentel-Nunes P et al. eP75 RISK FACTORS FOR METACHRONOUS LESIONS AFTER GASTRIC ENDOSCOPIC OR SURGICAL RESECTION - A SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S121.

Publication History

Article published online:
19 March 2021