Endoscopic staging and targeted biopsies for routine evaluation of precancerous gastric lesions

Rationale

Although there has been a decline in the incidence of gastric adenocarcinoma, particularly in the Western world, it remains a major cause of cancer mortality. The key to having a significant impact on not only the prognosis of gastric cancer but also its global economic burden is to accurately identify the individuals at risk and intervene prior to them establishing gastric cancer through surveillance and existing efficacious therapies, including endoscopic resection. By embracing the significant improvements in endoscopic technology and changing the staging paradigm to an endoscopy led approach we will empower the endoscopist to risk stratify individuals with greater accuracy and decrease the already huge burden placed on our endoscopy and histopathology departments.

Objective

To evaluate the accuracy and reproducibility of enhanced endoscopic imaging for staging chronic atrophic gastritis.

Study design

Prospective evaluation of a diagnostic test

Study population

Patient already in surveillance for premalignant stomach lesions, or patients with new found lesions will be asked to participate in the current trial.

Intervention

Patients will be evaluated on separate occasions using standard white-light endoscopy plus random biopsies (current diagnostic strategy) and the using enhanced endoscopic imaging with targeted biopsies (proposed diagnostic strategy). We will compare both approaches using histopathology. Subsequently, a blood test will be drawn.

Enhanced endoscopic imaging, including high-definition white light endoscopy and virtual chromoendoscopy, alongside targeted biopsies provides an accurate and reproducible assessment of chronic atrophic gastritis disease extent and staging, when compared to the current practice of white light endoscopy and random biopsies through the Sydney protocol biopsy strategy.

White light endoscopy with biopsies + serology samples at baseline

After 6 months narrow band imaging endoscopy with biopsies

: Patients will be evaluated on separate occasions using standard white-light endoscopy plus random biopsies (current diagnostic strategy) and the using enhanced endoscopic imaging with targeted biopsies (proposed diagnostic strategy). We will compare both approaches using histopathology. Subsequently, a blood test will be drawn.