Tackling Post-Endoscopy Gastric Cancer in a Low-Risk Area: Prevalence, Features, and Prevention Opportunities Through Better Clinical Practice

Abstract

Background: Post-endoscopy gastric cancer (PEGC) is a gastric cancer (GC) diagnosed within 3 years after an esophago-gastro-duodenoscopy (EGD) negative for cancer. Post-endoscopy gastric cancer has a prevalence of 9%–11% in the western population and is potentially reducible through adequate surveillance and high-quality endoscopy. However, Post-Endoscopy Gastric Cancer features are not well defined. Objectives: Define Post-Endoscopy Gastric Cancer prevalence in a gastric cancer low-risk area as Spain, describe its characteristics and associated factors. Evaluate adherence to current recommendations for surveillance of preneoplastic gastric lesions and endoscopic quality indicators. Methods: A descriptive and analytical study included patients who met PEGC criteria and enrolled in the EpiGASTRIC registry—a national multicentric GC cohort—between April 2021 and May 2024. Results: Of 289 gastric cancer patients analyzed, 21 (7.3%) presented with PEGC. No differences were found between PEGCs and new-onset gastric cancers (NOGC) regarding clinical-demographic characteristics (males 52.4%, 65 years, caucasians 78.9%, previous Helicobacter pylori infection 56.3%) except for use of proton pump inhibitors (PPI) (81.0% vs. 44.9%, p-value = 0.002). Distal stomach (antrum and/or incisure) was more frequently affected in PEGC compared with NOGC (71.4% vs. 46.2%; p-value = 0.022), without differences in tumoral staging (I–II 52.4%) or histology (intestinal type 47.6%). Median time from last negative-for-cancer EGD to diagnosis was 13.6 months (interquartile range 4.1–26.8), with 38.1% of precursor lesions in previous endoscopy (19% chronic atrophic gastritis with metaplasia, 19% dysplasia). Considering last negative-for-cancer EGD, adherence to current recommendations was 66.6% for the surveillance of gastric lesions, and 14.3% for quality indicators (complete procedure 100%, high-definition 38.1%, chromoendoscopy 10.0%). Conclusions: PEGC patients present a higher rate of distal stomach involvement and use of PPIs. Although precursor gastric lesions are commonly identified, adherence to current recommendations for their surveillance and to established quality indicators in EGDs is scarce. Despite its low prevalence, there is room for improvement to enhance the early detection and prevention strategies for PEGC.