Ricerc@Sapienza

Background: Atrophic gastritis (AG) is at increased risk of gastric neoplasia, thus surveillance gastroscopy
has been proposed.
Aims: To assess cost of detecting gastric neoplasias by surveillance endoscopy according to identified risk
factors in Italy.
Methods: Post-hoc analysis of a cohort study including 200 AG-patients from Italy followed up for a mean
of 7.5 (4–23.4) years was done. Considered risk factors were: age >50 years, extensive atrophy, pernicious
anaemia, OLGA-OLGIM scores 3–4 at diagnosis. The number of 4-year-surveillance endoscopies needed
to be performed to detect one gastric neoplasia (NNS) was calculated.
Results: In 19 patients neoplasias (4 gastric cancers, 8 type 1 gastric carcinoids, 7 dysplasias) were detected
at the 361 surveillance gastroscopies, corresponding to NNS of 19 and a cost per gastric neoplastic lesion
of D 2945. By restricting surveillance to pernicious anaemia patients, reduction of NNS and cost per
neoplasia to 13.8 and D 2139 may be obtained still detecting 74% of neoplasias. By limiting the surveillance
to pernicious anaemia patients and OLGA 3–4, 5 (26.3%) neoplasias would have been detected with a
corresponding NNS of 5.4 and a cost per lesion of D 837.
Conclusion: Risk factors may allow an efficient allocation of financial and medical resources for endoscopic
surveillance in AG in a low risk country