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The use of intensive index endoscopy was not associated with subsequently reduced detection of new gastric cancers after 1 year for high-risk patients, according to a case-control study from Japan.

Early gastric cancer detection after index endoscopy with both white light and narrow-band imaging (3%) was similar to the rate of new gastric cancer detected on surveillance endoscopy within 15 months afterward (2.6%), reported Manabu Muto, MD, PhD, of the Kyoto University Graduate School of Medicine in Japan and colleagues, writing in .

The analysis of more than 4,500 patients' data turned up two independent risk factors: open-type atrophic gastritis (OR 6.00, 95% CI 2.25-16.01) and early detection by index endoscopy (OR 4.67, 95% CI 1.08-20.21).

Repeat endoscopy for surveillance at 1 year may be necessary for high-risk patients, "especially those with atrophic gastritis or a history of GC [gastric cancer]," the group wrote. They also suggested shorter surveillance intervals for those with advanced stages of atrophic gastritis.

Of the 3% (n=133) with early gastric cancer found during index endoscopy, 82.7% underwent surveillance endoscopy within 15 months, and this group had a 10.9% rate of newly detected gastric cancer.

"The results of this analysis may provide new reference criteria for the detection rate of new GC in patients with high risk," Muto's group wrote.

The detection of gastric cancer is often missed with a single endoscopic examination, even though multiple forms of imaging may be used, Muto's group noted.

Reached for comment, Matthew Kroh, MD, of the Cleveland Clinic in Ohio, noted the "very high likelihood" of having an early gastric cancer diagnosis in patients with atrophic gastritis or with a prior history of gastric cancer.

"This is very important because it's not a single lesion that we're looking at," he said.

"This patient population will be at risk for additional gastric cancers in the future, which has significant morbidity and mortality," continued Kroh, who was not involved in this study. He noted that the study has important implications for better understanding "how this disease progresses and how we can better identify it early so that patients can undergo minimally invasive resection."

Their study was a preplanned secondary analysis of a comparing modalities during the index endoscopy, with the 4,523 patients ages 20 to 85 randomized 1:1 to receive an index endoscopy examining the entire stomach twice by second-generation narrow-band imaging followed by white light imaging or white light imaging first, followed by narrow-band imaging. The analysis was the "first large prospective analysis" to examine new gastric cancer detection rates of surveillance endoscopy within 1 year of having an index endoscopy.

Participants were at high risk for gastric cancer based on prior endoscopic resection of a gastric neoplasm or esophageal cancer, current gastric neoplasm or esophageal cancer, or chemotherapy or radiotherapy for esophageal cancer. They were enrolled at 13 hospitals in Japan from 2014 to 2017.

Among those who underwent index endoscopy (n=4,472), most underwent surveillance endoscopy (n=4,146) between 9-15 months later, with biopsies obtained for any lesions. Overall mean age was 71, and 78% of the participants were men. Most had a history of gastric neoplasm (83%), while 17% had prior esophageal cancer.

For the analysis of risk factors, 107 of those with newly detected gastric cancer were matched -- by sex, age, history of neoplasm, institution, and registration period -- to 107 control patients without recently detected gastric cancer within 15 months following their index endoscopy.

Characteristics were similar across both the case group and control: 88% were men, mean age was 72, and most had a gastric neoplasm (77-81%).

Among the 120 new gastric cancers detected on surveillance endoscopy in the 107 patients, most were smaller than 20 mm (86%) with a flat or depressed morphology (81%).

After reviewing the archived images, researchers found that lesions had been present in about half of the subsequently detected gastric cancer cases, with 17.5% retrospectively diagnosed as cancer.

The authors acknowledged limitations to the data. The type of image-enhanced endoscopy used during surveillance was not specified. Some patient data were retrospectively collected.

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