Follow-up of precancerous conditions of the stomach to prevent cancer development

We tried to see if there was enough evidence to support the idea of following up patients with precancerous conditions of the stomach to prevent cancer. This would usually be done by means of an examination of the patient's stomach with a camera inserted via the mouth (an endoscopy) and the removal of small samples of tissue from the stomach (biopsy). An alternative means of follow-up would be by a blood test measuring for a chemical called pepsinogen, although this is somewhat less accurate or reliable for diagnosis of stomach cancer. This is known as biochemical surveillance. We searched biomedical literature databases and abstracts of conference proceedings for details of any clinical trials. We found that there was no suitable evidence from randomised controlled trials to prove this, but that some studies that have been carried out would support looking into it more closely.

Authors' conclusions: 

There is a lack of randomised data on the utility of surveillance of GIM. The observational data from non-randomised studies are discussed and would suggest that although a randomised trial would be a desirable undertaking to attain the highest grade of clinical evidence, given the ethical and acceptability issues involved, further non-randomised clinical studies focussing on surveillance protocols and the role of Helicobacter pylori eradication may be a more pragmatic means of addressing the core clinical question.

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Background: 

Adenocarcinoma of the stomach is the second leading cause of cancer related death in the world. Gastric intestinal metaplasia (GIM) is a recognised premalignant condition of the stomach. It has been described as occurring in up to one in five patients in western countries. Although there is a definite risk of progression from GIM to cancer, published guidelines and statements differ as to the utility and structure of surveillance programs for this condition.

Objectives: 

To see whether or not endoscopic or biochemical surveillance of patients with gastric intestinal metaplasia (GIM) could result in increased detection of dysplasia and early gastric cancer to decrease gastric cancer mortality.

Search strategy: 

We performed a search of the following electronic databases from inception to October 2012: CENTRAL, EMBASE, MEDLINE and LILACS. We handsearched for abstracts from relevant conferences.

Selection criteria: 

Randomised controlled trials only were included.

Data collection and analysis: 

No studies met the inclusion criteria.

Main results: 

No studies met the inclusion criteria.

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