Background and study aim: Malignant change can occur in gastric ulcer but guideline recommendations for follow-endoscopy
(FU-OGD) are conflicting. This study aims to determine rate of malignancy and need
for follow-up for gastric ulcers.
Patients and methods: Patients with a first diagnosis of gastric ulcer between January 2012 and September
2013 were studied by analyzing endoscopic assessments, dysplasia, and malignancy yield
and the influence of risk factors on the likelihood of benign disease.
Results: In a cohort of 432 patients with gastric ulcer (53 % male, mean age 65 years) dysplasia
or neoplasia were found in 27 (19 adenocarcinomas, 2 cases of dysplasia, 5 lymphomas,
1 melanoma; malignancy yield 6 %). Twenty-five (93 %) cases were diagnosed on first
biopsy. The cancer yield of FU-OGD after initially benign biopsy was 0.9 %. Binary
logistic regression analysis revealed that endoscopically benign appearance (odds
ratio 0.004 95 % CI 0 – 0.576; P = 0.029), benign histology on first biopsy (odds ratio 0 95 % CI 0 – 0.39; P = 0.011) and lower number of ulcers (odds ratio 0.22 (95 % CI 0.05 – 0.99); P = 0.049) were independent predictors of benign disease. All dysplastic and neoplastic
cases would have been identified by a combination of initial biopsies plus repeat
endoscopy with further biopsies for endoscopically suspicious appearances.
Conclusions: In this large cohort 6 % of gastric ulcers were found to be malignant, highlighting
the need for all gastric ulcers to be biopsied. The cancer yield of FU-OGD after benign
biopsies was low. We have demonstrated that the combination of benign index histology
and no endoscopic suspicion of malignancy can predict benign disease. We recommend
that all gastric ulcers to be biopsied. Risk stratification could potentially reduce
need for FU-OGD.
