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The Baveno VII guidelines were proposed to identify which patients could safely avoid screening esophagogastroduodenoscopy (EGD) for gastroesophageal varices. We aimed to evaluate the frequency of gastric neoplasia in compensated advanced chronic liver disease (cACLD) patients who underwent EGD for screening of gastroesophageal varices (GOEV) compared to a healthy population. Retrospective study that enrolled all cACLD patients who underwent EGD for GOEV screening (January 2008-June 2018) in a tertiary reference center. cACLD patients were compared with asymptomatic healthy individuals who underwent EGD in a private hospital setting (April 2017-March 2018). We evaluated 1845 patients (481 cACLD patients, 1364 healthy individuals). A significantly higher frequency of gastric neoplasia was observed in patients with cACLD compared to healthy individuals (4.0% vs. 1.0 %; p < 0.001). Rare histopathological subtypes (WHO Classification) accounted for 28.7 % of gastric carcinoma cases in the cACLD cohort. Seven cases of gastric neoplasia (36.8 % of gastric neoplasia cases in the cACLD patients) were diagnosed in patients who, according to the Baveno VII criteria, would have not been submitted to EGD. We found an increased frequency of gastric neoplasia in patients with cACLD in comparison with healthy individuals. In countries with intermediate-high risk for GC, continuing to perform EGD could be beneficial. [ABSTRACT FROM AUTHOR]

Background and Aims: Gastric cancer (GC) is the third cause of cancer mortality worldwide. A screening strategy that combines an upper gastrointestinal endoscopy (UGIE) with a screening colonoscopy may be cost‐effective in intermediate‐risk regions. This study aimed to evaluate the intention to adhere to combined endoscopic screening and assess knowledge of GC symptoms, risk factors, and barriers to screening. Methods: Cross‐sectional study enrolling individuals eligible for CRC screening in northern Portugal, where a populational fecal occult blood test (FOBT) program is implemented. The validated PERCEPT‐PREVENT tool was applied across three groups: (a) not yet invited to CRC screening, (b) FOBT‐positive referred to colonoscopy, and (c) primary colonoscopy screening. Results: A high acceptance rate was observed for combined endoscopic screening (94%; n = 264) [not yet invited to CRC screening 98% (n = 90) vs. FOBT‐positive referred to colonoscopy 90% (n = 103) vs. primary colonoscopy 97% (n = 71); p = 0.017], with the vast majority reporting intention to adhere in the setting of full reimbursement (97%; n = 255). Most respondents were unaware of any possible GC symptom (76%; n = 213), risk factor (73%; n = 205), and UGIE‐related complication (85%; n = 237). Regular follow‐up with the primary care physician (Odds Ratio (OR) 27.59, 95% confidence interval (CI) 2.99–254.57), lower perceived negative health consequences of UGIE (OR 1.40, 95% CI 1.13–1.74), and lower perceived financial burden (OR 2.46, 95% CI 1.04–5.85) were the only factors independently associated with a higher intention to undergo combined screening. Conclusions: Willingness to undergo combined endoscopic screening was notably high and positively impacted by lower perceived barriers. Additional efforts should be undertaken to improve levels of digestive health literacy. [ABSTRACT FROM AUTHOR]

Simple Summary: This research set out to systematically review available cost-effectiveness studies on gastric cancer (GC) screening across the world. Of the studies reviewed, the majority were model-based, while fewer were prospective observational-based studies. The results of the review point to a distinction between Asian-based and non-Asian-based studies. The data revealed a higher risk of GC in Asian countries and their diasporas because of the elevated prevalence of one of the main risk factors within this population group, i.e., Helicobacter pylori (Hp) infections, compared with non-Asian populations. GC screening was mainly cost-effective in these high-risk groups, with a probability of at least 85% compared to no screening. Primary intervention, which involves Hp screening with eradication, was a preferred strategy as it addresses the main causative factor and limits the development of GC. Secondary intervention, which involves endoscopic screening, was also cost-effective but is typically used to identify adenocarcinomas rather than precancerous conditions. GC screening was generally not cost-effective among Western countries. Gastric cancer (GC) poses notable economic and health burdens in settings where the incidence of disease is prevalent. Some countries have established early screening and treatment programs to address these challenges. The objectives of this systematic review were to summarize the cost-effectiveness of gastric cancer screening presented in the literature and to identify the critical factors that influence the cost-effectiveness of screening. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluation studies of gastric cancer screening were reviewed from SCOPUS and PubMed. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) was used to assess the quality of reporting presented in the selected articles. Only primary economic evaluation studies addressing the cost-effectiveness, cost–utility, and cost–benefit of gastric cancer screening were selected. Two reviewers scrutinized the selected articles (title, abstract, and full text) to determine suitability for the systematic review based on inclusion and exclusion criteria. Authors' consensus was relied on where disagreements arose. The main outcome measures of concern in the systematic review were cost, effectiveness (as measured by either quality-adjusted life years (QALY) or life-years saved (LYS)), and incremental cost-effectiveness ratio (ICER) of screening versus either no screening or an alternative screening method. Thirty-one studies were selected for the final review. These studies investigated the cost-effectiveness of GC screening based on either primary, secondary, or a combination of primary and secondary interventions. The main primary intervention was Helicobacter pylori (Hp) screening with eradication, while the main secondary intervention was endoscopic screening. Cost-effectiveness was evaluated against no screening or screening using an alternative method in both observational and model-based studies. Screening was mainly cost-effective in Asian countries or their diasporas where the prevalence of GC was high. GC screening was generally not cost-effective among Western countries. GC screening can be cost-effective, but cost-effectiveness is dependent on context-specific factors, including geographical location, the prevalence of GC in the local population, and the screening tool adopted. However, there is benefit in targeting high-risk population groups in Asian countries and their diaspora for GC screening. [ABSTRACT FROM AUTHOR]

Purpose This study assessed the temporal trends of uptake of national general health and cancer screening among women with breast cancer in Korea between 2009 and 2016. Materials and Methods We retrospectively analyzed the claims data from the Korean National Health Insurance Service database. Participants included 101,403 breast cancer patients diagnosed between 2009 and 2016. Information on participation in national screening programs, including breast cancer screening, general health, and gastric, colorectal, and cervical cancers, up to 2020 was collected. Screening participation rates within the first 2 and 5 years postdiagnosis were calculated by diagnosis year and fitted with joinpoint regression models to assess temporal trends. Results Overall, the participation rate in breast cancer screening within 2 years postdiagnosis increased from 10.9% to 14.0% from 2009-2016, with an annual percentage change (APC) of 3.7% (p < 0.05). The participation rate in breast cancer screening was lower than that in general health checkup and screening for other cancers within 2 and 5 years postdiagnosis. A steady increase in screening trends was also observed for general health, gastric, colorectal, and cervical cancers, with APC of 5.3%, 5.7%, 6.9%, and 7.6% in the 2-year postdiagnosis rate, and APC of 3.6%, 3.7%, 3.7%, and 4.4% in 5-year postdiagnosis rate, respectively. The screening rate was highest among age groups 50-59 and 60-69 in 2009 and significant upward trends were observed in all age groups for general health checkup and gastric, colorectal, and cervical cancer screening. Conclusion Among female breast cancer survivors in Korea, the uptake rate of screenings for general health and various cancers, including breast, gastric, colorectal, and cervical cancers, has shown a gradual increase in recent years. [ABSTRACT FROM AUTHOR]

Simple Summary: Advances in gastric cancer screening and endoscopic technology have made it possible to detect and treat gastric cancer at an early stage. As a result, about 40% of all gastric cancers have now been resected via endoscopic treatment in Japan. In endoscopic diagnosis, magnifying endoscopic observation using band-limited light such as narrow-band imaging (NBI) has significantly improved the accuracy of gastric cancer diagnosis. At the same time, in endoscopic treatment, endoscopic submucosal dissection (ESD) has contributed to notably increasing the number of gastric cancers that can be resected endoscopically. In recent years, the construction of algorithms for endoscopic diagnosis and treatment with a view to personalized medicine has been explored, and the use of endoscopy for gastric cancer management is expected to develop further in the future. Endoscopy is mandatory to detect early gastric cancer (EGC). When considering the cost-effectiveness of the endoscopic screening of EGC, risk stratification by combining serum pepsinogen values and anti-H. pylori IgG antibody values is very promising. After the detection of suspicious lesions of EGC, a detailed observation using magnifying endoscopy with band-limited light is necessary, which reveals an irregular microsurface and/or an irregular microvascular pattern with demarcation lines in the case of cancerous lesions. Endocytoscopy enables us to make an in vivo histological diagnosis. In terms of the indications for endoscopic resection, the likelihood of lymph node metastasis and technical difficulties in en bloc resection is considered, and they are divided into absolute, expanded, and relative indications. Endoscopic mucosal resection and endoscopic submucosal dissection are the main treatment modalities nowadays. After endoscopic resection, curability is evaluated histologically as endoscopic curability (eCura) A, B, and C (C-1 and C-2). Recent evidence suggests that the outcomes of endoscopic resection for many EGCs are comparable to those of gastrectomy and that endoscopic resection is the gold standard for node-negative early gastric cancers. Personalized medicine is also being developed to overcome the unmet needs in treatments of EGC, for example the further expansion of indications and newer resection techniques, such as full-thickness resection. [ABSTRACT FROM AUTHOR]

Helicobacter pylori is the most common chronic bacterial infection worldwide and the most significant risk factor for gastric cancer, which remains a leading cause of cancer-related death globally. H pylori and gastric cancer continue to disproportionately impact racial and ethnic minority and immigrant groups in the United States. The approach to H pylori case-finding thus far has relied on opportunistic testing based on symptoms or high-risk indicators, such as racial or ethnic background and family history. However, this approach misses a substantial proportion of individuals infected with H pylori who remain at risk for gastric cancer because most infections remain clinically silent. Moreover, individuals with chronic H pylori infection are at risk for gastric preneoplastic lesions, which are also asymptomatic and only reliably diagnosed using endoscopy and biopsy. Thus, to make a significant impact in gastric cancer prevention, a systematic approach is needed to better identify individuals at highest risk of both H pylori infection and its complications, including gastric preneoplasia and cancer. The approach to H pylori eradication must also be optimized given sharply decreasing rates of successful eradication with commonly used therapies and increasing antimicrobial resistance. With growing acceptance that H pylori should be managed as an infectious disease and the increasing availability of susceptibility testing, we now have the momentum to abandon empirical therapies demonstrated to have inadequate eradication rates. Molecular-based susceptibility profiling facilitates selection of a personalized eradication regimen without necessitating an invasive procedure. An improved approach to H pylori eradication coupled with population-level programs for screening and treatment could be an effective and efficient strategy to prevent gastric cancer, especially in minority and potentially marginalized populations that bear the heaviest burden of H pylori infection and its complications. [ABSTRACT FROM AUTHOR]

(1) Background: Saudi Arabia (SA) is a country with a low incidence of gastric cancer (GC). In this study, we sought to assess the epidemiology of GC, its clinicopathological profiles, and its association with risk factors as well as to identify premalignant gastric lesions (PGL) and examine neoplastic progression. (2) Methods: This five-year prospective study screened for GC and PGL in asymptomatic Saudi patients, aged 45–75 years (n = 35,640) and living in Al Kharj, Riyadh province in central SA. Those who were positive in a high-sensitivity guaiac fecal occult blood test (HSgFOBT+) and had negative results in colonoscopy offered to undergo upper GI endoscopy (n = 1242). Factors associated with GC were examined. (3) Results: The five-year participation rate was 87% (1080/1242). The incidence rate of GC was 26.9 new cases per 100,000 population per year (9.6 new cases per year/total population at risk—35,640), and it was 8.9 cases per 1000 persons per year among the 1080 subjects with HSgFOBT+ and negative colonoscopy results. The five-year mortality rate was 67% among patients with GC (n = 48), 3.0% among participants in the gastric screening program (n = 1080) and 0.09% among the original population participating in the colorectal screening program (n = 35,640). Intestinal-type adenocarcinoma was the most frequent type (77%), with the tumor most commonly located in the antrum (41%). Overall, 334 participants had PGL, and seven of them (2.1%) showed neoplastic progression to GC during the follow-up. Factors associated with GC were age, Helicobacter pylori (HP) infection, obesity (body mass index BMI > 30), smoking, a diet of salty preserved foods, low income and a family history of GC. (4) Conclusions: The incidence of GC is low in central SA, but screening for PGL and GC among patients with HSgFOBT+ and negative colonoscopy may prevent or result in the early treatment of GC. HP eradication, normal body weight, not smoking and adhering to a healthy diet can reduce the risk of GC. The resulting data provide important input for the improvement of national guidelines.

Objective: Helicobacter pylori infections increase gastric cancer risk. Detecting and eradicating Helicobacter pylori infections and implementing a follow-up strategy should be considered by occupational health practitioners. This study aimed to evaluate the cost-effectiveness of adding an H. pylori antibody (HPA) test to current gastric cancer screening using upper gastrointestinal series (UGI) at the workplace in Japan. Methods: The data of Japanese people aged ≥40 years were collected from PubMed and evaluated in two cohorts: UGI (X-ray examination)+HPA test and UGI only. A Markov model was used for the cost-effectiveness analysis of the UGI+HPA test and UGI-only cohorts. The main outcomes were cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The impact of uncertainty was assessed using one-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA). Results: A base-case analysis showed that the UGI+HPA test strategy was less costly (−US＄1,039 and −US＄1,496) and more effective (0.415 and 0.437 QALYs) than the UGI-only strategy in the 40- and 50-year-old groups, respectively. The UGI+HPA test strategy was assessed as a dominant strategy. In the OWSA, the tornado diagram showed negative expected costs and positive QALY gains within the established ranges for all parameters. In the PSA, more than 95% of the simulations demonstrated ICER

(1) Background: Saudi Arabia (SA) is a country with a low incidence of gastric cancer (GC). In this study, we sought to assess the epidemiology of GC, its clinicopathological profiles, and its association with risk factors as well as to identify premalignant gastric lesions (PGL) and examine neoplastic progression. (2) Methods: This five-year prospective study screened for GC and PGL in asymptomatic Saudi patients, aged 45–75 years (n = 35,640) and living in Al Kharj, Riyadh province in central SA. Those who were positive in a high-sensitivity guaiac fecal occult blood test (HSgFOBT+) and had negative results in colonoscopy offered to undergo upper GI endoscopy (n = 1242). Factors associated with GC were examined. (3) Results: The five-year participation rate was 87% (1080/1242). The incidence rate of GC was 26.9 new cases per 100,000 population per year (9.6 new cases per year/total population at risk—35,640), and it was 8.9 cases per 1000 persons per year among the 1080 subjects with HSgFOBT+ and negative colonoscopy results. The five-year mortality rate was 67% among patients with GC (n = 48), 3.0% among participants in the gastric screening program (n = 1080) and 0.09% among the original population participating in the colorectal screening program (n = 35,640). Intestinal-type adenocarcinoma was the most frequent type (77%), with the tumor most commonly located in the antrum (41%). Overall, 334 participants had PGL, and seven of them (2.1%) showed neoplastic progression to GC during the follow-up. Factors associated with GC were age, Helicobacter pylori (HP) infection, obesity (body mass index BMI > 30), smoking, a diet of salty preserved foods, low income and a family history of GC. (4) Conclusions: The incidence of GC is low in central SA, but screening for PGL and GC among patients with HSgFOBT+ and negative colonoscopy may prevent or result in the early treatment of GC. HP eradication, normal body weight, not smoking and adhering to a healthy diet can reduce the risk of GC. The resulting data provide important input for the improvement of national guidelines. [ABSTRACT FROM AUTHOR]

Gastroscopy is a widely adopted method for gastric cancer screening and early diagnosis. Clinical studies show that it can effectively prolong patient life and maximise therapeutic effect. However, it is difficult for doctors to identify and detect lesions in real time, which manifests as the major challenge in gastroscopy. In this paper, we propose SCEG, a smart connected electronic gastroscopy system that performs dynamic cancer screening in gastroscopy. By integrating electronic gastroscopy with cloud-based medical image analysis service, we develop an AdaBoost-based multi-column convolutional neural network (MCNN) for enhancing gastric cancer screening. Experimental results show that the proposed MCNN approach significantly outperforms other competing approaches. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical value of serum PGI, PGII, PGI/PGII, G-17 levels and Hp-IgG antibody in the preliminary screening of gastric diseases. Methods: A total of 300 patients who underwent gastroscopy in the Gastroenterology Department of our hospital from July 2018 to July 2020 due to gastric diseases were selected as the research objects. According to gastroscopy and pathological examinations, they were divided into chronic superficial gastritis group,chronic atrophic gastritis group and gastric cancer group. 100 healthy patients from the physical examination center during the same period were selected as the control group. The serum PGI, PGII, PGI/PGII G17 levels and the positive rate of Hp-IgG antibody in each group were compared. Results: Serum PGI/PGII levels in gastric cancer group(10.42±4.63) and atrophic gastritis group (10.54±4.36) were lower than those in control group (12.07±6.80). Serum G-17 levels in gastric cancer group [(13.85±27.68） pmmol/L] and chronic atrophic gastritis group [(9.63±10.82) pmmol/L] were higher than those in control group [(6.02±7.30) pmmol/L]. The serum PGI level in gastric cancer group[(123.53±35.45) μg/L] was lower than that in the control group[(148.24±83.85) μg/L and chronic superficial gastritis group [(141.95±81.11) μg/L]. The differences were statistically significant (P

Objective: This study was aimed at investigating the screening behaviors of the first-degree relatives (FDRs) of Chinese patients with gastric cancer as well as the factors influencing screening behaviors. Methods: In a cross-sectional design, 197 FDRs of patients with gastric cancer were enrolled at the Peking University Cancer Hospital. Four questionnaires were used: a demographic questionnaire, a knowledge questionnaire of risk factors and warning symptoms for gastric cancer, the Gastric Cancer Health Belief Scale, and a questionnaire screening for behavioral motivators and barriers. Logistic regression analysis was performed to determine the factors influencing screening behaviors. Results: Among the 197 FDRs of patients with gastric cancer, 30.96% (61/197) of patients had undergone gastric cancer screening. Among those who participated in gastric cancer screening, the most common screening methods were gastroscopy and the Helicobacter pylori testing, both of which were applied in 63.93% (39/61) of participants, followed by serum tumor marker testing (55.74%, 34/61) and barium meal examination of the upper digestive tract (29.51%, 18/61). The gastric cancer risk factor knowledge score was 9.02 ​± ​3.95, and the gastric cancer warning symptom knowledge score was 4.39 ​± ​1.85. The participants’ knowledge score was moderate, at 13.41 ​± ​5.16. The total health beliefs score was low, at 88.91 ​± ​12.66. Factors independently associated with the screening behaviors of FDRs included educational background, knowledge of gastric cancer risk factors, and health motivation (P ​

Screening endoscopy has advanced to facilitate improvements in the detection and prognosis of gastric cancer. However, most early gastric cancers (EGCs) have subtle morphological or color features that are difficult to detect by white-light imaging (WLI); thus, even well-trained endoscopists can miss EGC when using this conventional endoscopic approach. This review summarizes the current and future status of linked color imaging (LCI), a new image-enhancing endoscopy (IEE) method, for gastric screening. LCI has been shown to produce bright images even at a distant view and provide excellent visibility of gastric cancer due to high color contrast relative to the surrounding tissue. LCI delineates EGC as orange-red and intestinal metaplasia as purple, regardless of a history of Helicobacter pylori (Hp) eradication, and contributes to the detection of superficial EGC. Moreover, LCI assists in the determination of Hp infection status, which is closely related to the risk of developing gastric cancer. Transnasal endoscopy (ultra-thin) using LCI is also useful for identifying gastric neoplastic lesions. Recently, several prospective studies have demonstrated that LCI has a higher detection ratio for gastric cancer than WLI. We believe that LCI should be used in routine upper gastrointestinal endoscopies. [ABSTRACT FROM AUTHOR]

Background /Aims: The serum pepsinogen (PG) assay is used to screen subjects at high risk for gastric cancer. Currently, there are few studies on the PG levels for the detection of Helicobacter pylori infection. This study aimed to determine the PG assay findings for detecting ongoing infection. Methods: Asymptomatic subjects who underwent a 13C-urea breath test (13C-UBT) on the day of gastroscopy and serum assay for cancer screening were included. Subjects with a recent intake of acid suppressants or antibiotics, gastrectomy, or renal failure were excluded. H. pylori infection was defined as a positive 13C-UBT result. Results: Among the 500 included subjects, 167 (33.4%) had current infection. The serum PG II levels of > 12.95 ng/mL (area under the curve [AUC] = 0.930, sensitivity 86.5%, specificity 90.7%) and PG I/II ratios of < 4.35 (AUC = 0.875, sensitivity 86.8%, specificity 79.6%) were related to infection. The PG I/II ratios were inversely correlated with age (r = -0.160, p = 0.039). The cutoff values of PG I/II ratios were lower in older subjects aged ≥ 50 years (< 4.05; AUC = 0.875, sensitivity 80.7%, specificity 88.2%) than in younger subjects aged < 50 years (< 4.35; AUC = 0.873, sensitivity 77.4%, specificity 88.9%). Conclusions: Serum PG II levels > 12.95 ng/mL and PG I/II ratios < 4.35 suggest ongoing infection in asymptomatic subjects; therefore, H. pylori confirmation tests (i.e., 13C-UBT) should be considered under these conditions. Stricter criteria are required in older subjects aged ≥ 50 years (PG I/II ratio < 4.05) to detect ongoing infection than younger subjects. [ABSTRACT FROM AUTHOR]

Introduction and objective Gastric cancer (GC) is one of the biggest healthcare problems worldwide. Despite the fact that the incidence of this cancer has decreased recently, GC is in the fifth place of causes of morbidity, and in the second place of causes of mortality. Therefore, some countries such as Japan and South Korea have established and developed screening methods to detect GC as early as possible and to begin early treatment. Materials and method Review methods were based on articles available in the following databases: PubMed, UpToDate, among others. Brief description of the state of knowledge There are many types of screening methods, such as, markers of atrophy-serum-pepsinogen test and low serum gastrin-17 concentration, barium photofluorography of mucosa, or endoscopy. Upper gastrointestinal endoscopy has the highest detection rate in high-incidence areas, compared to other screening methods, because upper endoscopy makes it possible to highlight changes such as flat and non-ulcerative lesions, which are usually invisible in barium examination. An alternative to screening is the massive eradication of Helicobacter pylori. Some countries occasionally recommend genetic testing and prophylactic gastrectomy. Conclusions Despite the high incidence of GC in Asian countries, there is still a lack of data on the cost-effectiveness of mass screening for GC. The main factor influencing the profitability of screening tests for GC is the cost of upper gastrointestinal endoscopy. Moreover, the value and usefulness of the GC screening programme remains controversial in many countries

Helicobacter pylori infection results in gastric cancer (GC) with gastric mucosal atrophy (GMA). Some single-nucleotide polymorphisms (SNPs) in the prostate stem cell antigen gene (PSCA) are associated with GC and duodenal ulcers. However, the relationship of other identified SNPs in PSCA with these diseases remains unclear. Herein, the association between PSCA SNPs and GMA among 195 Japanese individuals with H. pylori infection was evaluated. The definition of GMA or non-GMA was based on serum pepsinogen levels or endoscopic findings. Five tag PSCA SNPs were analyzed using PCR high-resolution melting curve analysis with nonlabelled probes. The frequencies of alleles and the genotypes of each tag SNP were compared between the GMA and non-GMA groups. Subsequently, a genetic test was performed using associated SNPs as biomarkers to detect patients developing GMA. Two tag PSCA SNPs (rs2920280 and rs2294008) were related to GMA susceptibility. Individuals with the rs2920280 G/G genotype or the rs2294008 T/T genotype in PSCA had 3.5- and 2.1-fold susceptibility to GMA, respectively. In conclusion, SNP rs2920280 is a possible biomarker for detecting individuals developing GMA. PSCA polymorphisms may be useful biomarkers for predicting GMA linked to GC risk and a screening endoscopy strategy to detect GC related to early stage H. pylori associated GMA. [ABSTRACT FROM AUTHOR]

Gastric cancer is the second leading cause of cancer incidence in Japan, although gastric cancer mortality has decreased over the past few decades. This decrease is attributed to a decline in the prevalence of H. pylori infection. Radiographic examination has long been performed as the only method of gastric screening with evidence of reduction in mortality in the past. The revised 2014 Japanese Guidelines for Gastric Cancer Screening approved gastric endoscopy for use in population-based screening, together with radiography. While endoscopic gastric cancer screening has begun, there are some problems associated with its implementation, including endoscopic capacity, equal access, and cost-effectiveness. As H. pylori infection and atrophic gastritis are well-known risk factors for gastric cancer, a different screening method might be considered, depending on its association with the individual's background and gastric cancer risk. In this review, we summarize the current status and problems of gastric cancer screening in Japan. We also introduce and discuss the results of gastric cancer screening using H. pylori infection status in Hoki-cho, Tottori prefecture. Further, we review risk stratification as a system for improving gastric cancer screening in the future. [ABSTRACT FROM AUTHOR]

INTRODUCTION AND PURPOSE:Gastric cancer (GC) is one of the biggest healthcare problem in the world. Despite the fact that the incidence of this cancer has decreased recently, GC is on the fifth place of causes of morbidity and on the second place of causes of mortality. Therefore, some countries such as Japan and South Korea have decided to establish and develop screening methods to detect GC as early as it is possible and to begin early treatment.DESCRIPTION OT THE STAGE OF KNOWLEDGE:There are many types of screening methods such as: markers of atrophy- serum-pepsinogen test and low serum gastrin-17 concentration, barium photofluorography of mucosa or endoscopy. Upper gastrointestinal endoscopy has the highest detection rate in high-incidence areas, compared to other screening methods, because upper endoscopy makes it possible to highlight changes such as flat and non-ulcerative lesions, which are usually invisible in barium examination. An alternative to screening is the massive eradication of Helicobacter pylori. Occasionally some countries recommend genetic testing and prophylactic gastrectomy.CONCLUSIONS:Despite the high incidence of GC in Asian countries, there is still a lack of data on the cost-effectiveness of mass screening for GC. The main factor influencing the profitability of screening tests for GC is the cost of upper gastrointestinal endoscopy. Moreover, the value and usefulness of the GC screening program remains controversial in many countries.

This report presents two cases of colonic perforation that occurred following an upper gastrointestinal series (UGIS) with barium as part of a health screening. UGIS is a widely performed examination in Japan and is useful for the early detection of gastric cancer and peptic ulcers, but it carries a rare risk of causing serious gastrointestinal perforation. This study details the mechanisms of perforation, risk factors, difficulties in imaging diagnosis, and treatment options. Cases of perforation require early diagnosis and appropriate surgical intervention, with Hartmann's procedure or colostomy being the common choices. This case series emphasizes the need to recognize the potential risks associated with UGIS, even though it is considered relatively safe. With the advancement of endoscopic examination technology in recent years, endoscopy is increasingly being adopted as an alternative to UGIS in health screenings, and there is a need to reconsider future examination methods., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kidogawa et al.)

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Aim: To optimize gastric cancer screening score and reduce screening costs using machine learning models., Methods: This study included 228,634 patients from the Taizhou Gastric Cancer Screening Program. We used three machine learning models to optimize Li's gastric cancer screening score: Gradient Boosting Machine (GBM), Distributed Random Forest (DRF), and Deep Learning (DL). The performance of the binary classification models was evaluated using the area under the curve (AUC) and area under the precision-recall curve (AUCPR)., Results: In the binary classification model used to distinguish low-risk and moderate- to high-risk patients, the AUC in the GBM, DRF, and DL full models were 0.9994, 0.9982, and 0.9974, respectively, and the AUCPR was 0.9982, 0.9949, and 0.9918, respectively. Excluding Helicobacter pylori IgG antibody, pepsinogen I, and pepsinogen II, the AUC in the GBM, DRF, and DL models were 0.9932, 0.9879, and 0.9900, respectively, and the AUCPR was 0.9835, 0.9716, and 0.9752, respectively. Remodel after removing variables IgG, PGI, PGII, and G-17, the AUC in GBM, DRF, and DL was 0.8524, 0.8482, 0.8477, and AUCPR was 0.6068, 0.6008, and 0.5890, respectively. When constructing a tri-classification model, we discovered that none of the three machine learning models could effectively distinguish between patients at intermediate and high risk for gastric cancer (F1 scores in the GBM model for the low, medium and high risk: 0.9750, 0.9193, 0.5334, respectively; F1 scores in the DRF model for low, medium, and high risks: 0.9888, 0.9479, 0.6694, respectively; F1 scores in the DL model for low, medium, and high risks: 0.9812, 0.9216, 0.6394, respectively)., Conclusion: We concluded that gastric cancer screening indicators could be optimized when distinguishing low-risk and moderate to high-risk populations, and detecting gastrin-17 alone can achieve a good discriminative effect, thus saving huge expenditures., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Gastric cancers rarely metastasize to the bones. If they do, they have a very poor prognosis. We here present a case study of a 56-year-old man who, within a year, rapidly declined and died. He was first revealed to have an erosion found on an esophageal gastroduodenoscopy (EGD), which was later proven to be a poorly differentiated gastric adenocarcinoma. He then proceeded to have a thoracic trans-hiatal esophagogastrostomy with gastric pull-up to resect this cancer. At this point in time, the review of systems and CT scans of the abdomen and pelvis were negative. A few months later, he started having back pain and was diagnosed with metastatic disease of the bones through a CT scan. Although detecting gastric cancer at an early stage is rare, it is shown to have a better prognosis. It is, therefore, very important to reflect on the possibility of engaging in earlier screening to detect gastric cancers at an earlier stage to minimize the risk of invasions of other organs, especially for those who have other risk factors such as obesity and tobacco use. We believe it is prudent to ensure close follow-up with any patient with early gastric cancer to potentially detect recurrence or metastasis in a timely fashion., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ashikian et al.)

Objectives: To evaluate cost-effectiveness of a novel screening strategy using a microRNA (miRNA) blood test as a screen, followed by endoscopy for diagnosis confirmation in a 3-yearly population screening program for gastric cancer.Methods: A Markov cohort model has been developed in Microsoft Excel 2016 for the population identified to be at intermediate risk (Singaporean men, aged 50-75 years with Chinese ethnicity). The interventions compared were (1) initial screening using miRNA test followed by endoscopy for test-positive individuals and a 3-yearly follow-up screening for test-negative individuals (proposed strategy), and (2) no screening with gastric cancer being diagnosed clinically (current practice). The model was evaluated for 25 years with a healthcare perspective and accounted for test characteristics, compliance, disease progression, cancer recurrence, costs, utilities, and mortality. The outcomes measured included incremental cost-effectiveness ratios, cancer stage at diagnosis, and thresholds for significant variables.Results: The miRNA-based screening was found to be cost-effective with an incremental cost-effectiveness ratio of $40 971/quality-adjusted life-year. Key drivers included test costs, test accuracy, cancer incidence, and recurrence risk. Threshold analysis highlights the need for high accuracy of miRNA tests (threshold sensitivity: 68%; threshold specificity: 77%). A perfect compliance to screening would double the cancer diagnosis in early stages compared to the current practice. Probabilistic sensitivity analysis reported the miRNA-based screening to be cost-effective in >95% of iterations for a willingness to pay of $70 000/quality-adjusted life-year (approximately equivalent to 1 gross domestic product/capita) CONCLUSIONS: The miRNA-based screening intervention was found to be cost-effective and is expected to contribute immensely in early diagnosis of cancer by improving screening compliance. [ABSTRACT FROM AUTHOR]

Endoscopy is an important tool for gastric cancer screening. Due to the lack of effective decision support system for endoscopy, the detection of gastric cancer in the clinic is usually with low sensitivity. In this paper, we propose a Genetic Algorithm optimized Neural Network (GAoNN) approach for gastric cancer detection based on endoscopy reports mining. Considering the fact that gastric cancer sensitivity can significantly improve the 5‐year survival rate of patients, both the prediction accuracy and the sensitivity are employed to construct a multiobjective optimization model for enhancing the classification performance of GAoNN. In particular, we extended an effective genetic algorithm Nondominated Sorting Genetic Algorithm II (NSGA‐II) to train a neural network and reduced the complexity in training hyperparameters and improved the efficiency by substituting the computationally intensive stochastic gradient descent (SGD) algorithm in a neural network. Specifically, we designed the novel crossover and mutation operators and modified the nondominated ranking and crowding distance sorting procedures in NSGA‐II for GAoNN. Through testing on 8,546 real‐world endoscopy reports, we show that GAoNN achieves a prediction accuracy up to 83.74%, which is better than several competitors by significantly increasing sensitivity to 83.14%. GAoNN also reduces the training time by 30.94% when compared with conventional SGD‐based training, which indicates the feasibility of GAoNN in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the long history of cancer screening in Japan, the participation rates in gastric and colorectal cancer screenings have not increased. Strategies for improving the participation rates have been proposed, but differences in their effects among different age groups remain unclear. Methods The Japanese government conducted a national survey in all municipalities in Japan in 2010 to investigate whether the implementation of promotion strategies increased participation in cancer screening. We investigated the association between age factors and strategies for promoting participation in cancer screening based on this national survey. Multiple regression analysis with generalized linear model was performed using the participation rates in gastric and colorectal cancer screenings as dependent variables, and the following strategies for promoting participation as independent variables: 1) personal invitation letters, 2) household invitation letters, 3) home visits by community nurses, 4) screenings in medical offices, and 5) free cancer screening programs. Results One thousand six hundred thirty nine municipalities for gastric cancer screening and 1666 municipalities for colorectal cancer screening were selected for the analysis. In gastric and colorectal cancer screenings, the participation rates of individuals aged 60–69 years was higher than those of other age groups. Personal and household invitation letters were effective promotion strategies for all age groups, which encouraged even older people to participate in gastric and colorectal cancer screenings. Screening in medical offices and free screenings were not effective in all age groups. Home visits were effective, but their adoption was limited to small municipalities. Conclusions To clarify whether promotion strategies can increase the participation rate in cancer screening among different age groups, 5 strategies were assessed on the basis of a national survey. Although personal and household invitation letters were effective strategies for promoting participation in cancer screening for all age groups, these strategies equally encouraged older people to participate in gastric and colorectal cancer screenings. If resource for sending invitation letters are limited, priority should be given to individuals who are in their 50s and 60s for gastric and colorectal cancer screening.

Abstract Background Although Korea and Japan have a national gastric cancer screening program, their screening intervals are different. The optimal screening interval of endoscopic screening in Japan was investigated based on the stage distributions of screen-detected gastric cancers. Methods Patients with gastric cancer detected by endoscopic and radiographic screenings were selected from the Niigata City Medical Association database. The stage distributions of the detected gastric cancers were compared among patients with different screening histories in both groups. Gastric cancer specific survival rates were analyzed using the Kaplan-Meier method with the log-rank test. Results There were 1585 and 462 subjects in the endoscopic and radiographic screening groups, respectively. In the endoscopic screening group, the stage IV proportion was lower in patients with screening history 1 and 2 years before diagnosis than in patients without screening history. Stage IV development was significantly related to the absence of screening history (p

Aims: Patients with atrophic gastritis unrelated to autoimmune gastritis (AIG) and without active Helicobacter pylori ( H.pylori ) infection or previous eradication therapy are considered to have previous Helicobacter pylori infection-induced atrophic gastritis (PHIG). This study aimed to clarify the clinical characteristics of patients with PHIG., Methods: Consecutive patients who underwent upper gastrointestinal endoscopy during the study period were enrolled in the study. Pepsinogen and gastrin levels, H. pylori serology, and endoscopic atrophic grade were assessed. Patients were divided into five groups based on their H. pylori status and disease history (PHIG, without H. pylori infection, with active H. pylori infection, with successful H. pylori eradication, and AIG). Their gastric cancer risk status was classified according to the ABC method of serological gastric cancer screening., Results: Of 536 consecutive patients who underwent upper gastrointestinal endoscopy during the study period, 318 were included (31 with PHIG, 77 without H. pylori infection, 101 with active H. pylori infection, 80 with successful H. pylori eradication, and 29 with AIG). Of the 31 patients with PHIG, 21 (68%) were H. pylori -seronegative ,  and 20 (65%) were classified as group A (normal pepsinogen, H. pylori -seronegative). Patients with PHIG accounted for 90.1% of the patients at high risk for gastric cancer misclassified as group A. The pepsinogen and H. pylori serological profiles of patients with PHIG were similar to those of patients with successful H. pylori eradication more than six years previously. A receiver-operating characteristic curve (ROC) analysis that included 13 patients with AIG and without active H. pylori infection and no previous eradication therapy and 31 patients with PHIG revealed that an endoscopic atrophy grade of O-III or greater according to the Kimura-Takemoto classification can predict AIG., Conclusions: Two-thirds of the patients with PHIG were misclassified as being at low risk (group A) according to the ABC method, suggesting that endoscopy is necessary for group A patients. The results of the serological evaluation of PHIG indicated that patients with PHIG may have experienced spontaneous H. pylori eradication, possibly because of the use of antibiotics for other conditions. Autoimmune gastritis should be considered in the presence of grade 0-III or greater gastric mucosal atrophy in patients with suspected PHIG, even if the autoantibody and histological findings are not available., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of Tokyo Dental College, Ichikawa General Hospital issued approval (I-21-43R). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kishikawa et al.)

Gastric adenocarcinoma is the most common type of gastric cancer in the United States. Multiple factors can predispose a patient to develop such a malignancy, including having a history of Helicobacter pylori infection, tobacco use, alcohol use, specific genetic mutations, and being of Asian or Hispanic descent. Surgery is currently the only curative treatment for localized disease. With metastatic disease, the rate of survival decreases significantly, and most often, the only treatment option is palliative chemotherapy with or without combination radiation therapy. In the case of a 58-year-old man diagnosed with a gastroesophageal junction type III gastric adenocarcinoma that extended into the distal esophagus, what was thought to be a resectable tumor had already invaded vital neighboring organs, therefore, we were unable to eradicate the disease from this patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jadhav et al.)

Background and Aims: There are limited efforts to address modifiable risk factors for gastric cancer (GC) among racial/ethnic groups at higher GC risk, which may reflect decreased public awareness of risk factors. Our primary aim was to assess baseline awareness of GC risk factors and attitudes/potential barriers for uptake of a GC screening program among high-risk individuals. Methods: Participants attended a linguistically and culturally targeted GC educational program in East Harlem (EH)/Bronx and Chinatown communities in New York City. Demographic information and relevant behavioral/lifestyle habits were collected. Participants' ability to identify GC risk factors and attitudes/barriers surrounding GC screening were assessed before and after the program. Results: Of the 168 included participants, most were female with 77% above age 70. Nearly half of participants in the EH/Bronx programs identified themselves as black and 63% as Hispanic/Latino; 93% of the Chinatown participants identified as Chinese. Among EH/Bronx participants, the majority correctly identified older age, smoking, alcohol, H. pylori, family history, race/ethnicity, excess salt, and preserved foods as risk factors. Among Chinatown participants, the majority correctly identified smoking, alcohol, race/ethnicity, and excess salt, although only 53% and 57.8% correctly identified H. pylori and preserved foods, respectively; the majority incorrectly answered that older age was not a major risk factor. The majority in both groups failed to identify male gender as higher risk and incorrectly identified stress and obesity as major risk factors. Participants were more concerned about the potential findings on GC screening tests than the risks and costs or having to take time off work. Conclusion: Among multiracial/ethnic groups of individuals presumably at higher risk for GC, we identified several gaps in baseline knowledge of both modifiable and non-modifiable GC risk factors. Culturally and linguistically appropriate educational interventions may be a worthwhile adjunctive intervention within the context of a targeted GC screening program. [ABSTRACT FROM AUTHOR]

Background: The latest version of Japanese guidelines for effective secondary prevention of gastric cancer recommend upper gastrointestinal series (UGI) and endoscopy in adults 50 years of age and older. A Helicobacter pylori antibody test and eradication (H. pylori screening) reduces gastric cancer risk. Objective: This study aimed to evaluate the cost-effectiveness of H. pylori screening, compared to UGI and endoscopy in high prevalence countries. Methods: We developed decision trees with Markov models using a healthcare payer perspective and a lifetime horizon. Targeted populations were hypothetical cohorts of asymptomatic individuals at the age of 50, 60, 70 and 80 years. We calculated per-person costs and effectiveness with discounting at a fixed annual rate of 3% and compared incremental cost-effectiveness ratios. Results:H. pylori screening was cost-saving and more cost-effective for individuals at the age of 50, 60, 70, and 80 than UGI and endoscopy. One-way and multiway sensitivity analyses showed the robustness of the cost-effectiveness results. Probabilistic sensitivity analyses using Monte-Carlo simulation for 10,000 trials demonstrated that H. pylori screening was cost-effective 100% of the time at a willingness-to-pay level of US$50,000/QALY gained. Conclusions:H. pylori screening for the adults 50 years of age and older could be cost-effective compared to UGI and endoscopy in high prevalence countries. The main reasons for the superiority of H. pylori screening are that an H. pylori antibody test has a higher sensitivity and specificity than UGI and endoscopy and the benefits to reduce gastric cancer incidence and mortality. [ABSTRACT FROM AUTHOR]

Highlights • Fluorescent immunochromatographic strip was developed for rapid and simultaneous detection of two gastric cancer screening biomarkers. • Based on a long-life LED light and full-closure optical path, a miniature and low-power fluorescence analytical device was designed. • Only 7.5 μL of plasma was needed to realize simultaneous detection of PG I and PG II within 15 min and the obtained results were comparable with ELISA. • The developed assay coupled with device was used for detecting 30 clinical samples, which has potential for mass screening of gastric cancer. Abstract Pepsinogen I (PG I) and pepsinogen II (PG II) are gastric disease-associated proteins that have been utilized as biomarkers for gastric cancer screening. However, the current methods for detecting PG I and PG II can barely satisfy the needs of mass screening, especially in remote areas. In this study, a rapid and sensitive fluorescent immunochromatographic test strip with a miniature analytical device (20.0 cm × 18.9 cm × 11.2 cm, 2.4 kg) was developed for the simultaneous determination of PG I and PG II in one sample in a single assay, which is promisingly suitable for the mass screening of gastric cancer. Under the optimum conditions, PG I and PG II concentrations as low as 2.6 ng/mL and 1.0 ng/mL could be detected in 15 min with only 7.5 μL plasma specimen, and no cross-reactivity was observed. The detection range was linear over 10.0–210.0 ng/mL for PG I and 3.0–63.0 ng/mL for PG II. The immunosensor also demonstrated high recoveries (93.6–110.8% for PG I and 95.4–110.4% for PG II) with low coefficient of variation (CV) (4.8–8.1% for PG I and 6.6–11.7% for PG II) when testing actual human plasma. The analyses by the proposed assay correlated well with those by ELISA of 30 spiked samples. The assay was finally applied to 30 clinical samples, and the results showed its clinical significance for the early screening of gastric cancer. Therefore, the assay proposed in this study provides a rapid, sensitive, and simultaneous detection strategy in the pepsinogen test, and the results indicated its potential capacity in the mass screening of gastric cancer. [ABSTRACT FROM AUTHOR]

The objective of this article is to highlight the clinical features, screening, diagnosis, treatment, and prevention of gastric cancer (GC). Early GC is often asymptomatic leading to frequent delays in diagnosis. Weight loss and persistent abdominal pain are the most common symptoms at initial diagnosis. The diagnosis of GC typically involves a combination of endoscopy, biopsy, and imaging studies. Endoscopic resection techniques are emerging as successful treatment options for early GC. Treatment options for advanced GC include surgery and chemotherapy. The first line chemotherapy for advanced GC consists of doublet therapy with a combination of platinum and fluoropyrimidines. Trastuzumab, a monoclonal antibody, is used in the treatment of human epidermal growth factor 2 positive GCs. Antiangiogenic agents and immunotherapy are also useful in the treatment of GC. Currently there are no GC screening guidelines in the United States, but they exist in other regions where there is increased prevalence of GC. Prevention strategies for GC include Helicobacter pylori eradication and adoption of a healthy diet consisting of fruits and vegetables., Competing Interests: Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article., (© 2024 Greater Baltimore Medical Center.)

Abstract Background A questionnaire that distinguishes how variability in gastric cancer prevalence is associated with ethnicity/birth country/immigration/cultural diet along with known risk factors may improve targeting populations for gastric cancer screening in the United States. Methods Existing literature was used to identify the item pool. Cluster analysis, focus groups, and cognitive interviewing were used to reduce collinear items and refine the questionnaire. Logistic regression analysis was used to determine which items distinguished gastric cancer cases from the primary care and community controls. Results The results of analysis of data from 40 cases and 100 controls (primary care = 47; community = 53) were used to reduce the 227 item pool to 12 items. After ranking these variables using model bootstrapping, a logistic regression model using the highest ranked eight variables was chosen as the final model. Older age, foreign nativity, daily consumption of cultural food at ages 15-18, less than high-school education, and greater acculturation were significantly associated with being a gastric cancer case compared with the controls. Conclusions An eight-item survey that addresses gastric cancer risk factors, ethnicity, cultural habits, and immigration patterns has potential to identify high-risk persons from multicultural areas within the US, who might benefit from endoscopic screening for gastric cancer. [ABSTRACT FROM AUTHOR]

Background Corpus-predominant gastritis index ( CGI) is an early histological marker to identify Helicobacter pylori-infected gastric cancer relatives at risk of cancer. This study validated whether CGI is more prevalent in H. pylori-infected nonulcer dyspepsia ( NUD) subjects than in duodenal ulcer ( DU) controls and whether it is reversible after H. pylori eradication or is correlated with noninvasive biomarkers. Materials and Methods In this longitudinal cohort study, 573 H. pylori-infected subjects were enrolled, including 349 NUD and 224 DU. Gastric specimens were provided to assess CGI, spasmolyic polypeptide-expressing metaplasia ( SPEM), and Operative Link on Gastric Intestinal Metaplasia assessment ( OLGIM). Serum pepsinogen I and II levels were assessed using enzyme-linked immunosorbent assay. CGI subjected were followed up at least 1 year after H. pylori eradication. Results NUD subjects had higher prevalence rates of CGI (47.0% vs 29.9%, P<.001) and OLGIM stages III- IV (24.1% vs 15.2%, P=.01) than controls. CGI was highly prevalent in NUD subjects after the age of 40, which was 10 years earlier than atrophic gastritis and intestinal metaplasia. NUD subjects with CGI had higher risk of SPEM ( OR 2.86, P<.001) and lower serum pepsinogen I/ II ratios ( P<.001) than those without CGI. Serum pepsinogen I/ II ratios <9 could predict CGI modestly ( AUROC 0.69, 95% CI: 0.63-0.74). CGI was regressed after eradication ( P<.001). Conclusions CGI was more prevalent in H. pylori-infected NUD subjects than in controls, was correlated with SPEM, and may serve as a marker earlier than OLGIM to indicate risk of gastric cancer. Moreover, CGI could be regressed after eradication. [ABSTRACT FROM AUTHOR]

Backgrounds/Aims: In the ABC method, which is a method for risk stratification of gastric cancer using serum anti- Helicobacter pylori antibody and pepsinogen (PG) test, subjects with normal PG and seronegative for H. pylori are named as "Group A" and are regarded as having a low risk of gastric cancer. These "Group A" subjects include unintentionally eradicated cases at relatively high risk, and this study aimed to identify these subjects. Methods: Of the 109 subjects, 76 were classified as uninfected Group A subjects with negative histologic H. pylori infection and no histologic and endoscopic atrophy, and 33 subjects were classified serologically as Group A after successful eradication, which are serologically equal to the unintendedly eradicated cases in Group A. The usefulness of measuring PG levels to detect post-eradication cases was validated by using a receiver operating characteristic (ROC) curve analysis. Results: The area under the ROC curve for PGI level was 0.736 ± 0.06 ( p < 0.01; cutoff value, 37.0 ng/mL; sensitivity, 77.6%; specificity, 72.7%), and that for the PGI/II ratio was 0.660 ± 0.06 ( p < 0.01; cutoff value, 5.1; sensitivity, 84.2%; specificity, 43.4%). Conclusion: PGI levels of ⩽ 37 ng/mL and PGI/II ratios of ⩽ 5.1 effectively identified unintendedly eradicated cases in Group A. [ABSTRACT FROM AUTHOR]

Purpose: To improve the detection and optimization of prevention of early cancers of the stomach through the development of endoscopic methods of diagnosis and treatment of dysplastic changes in gastric mucosa.Materials and Methods: In accordance with the intended purpose were examined 13 255 patients with atrophic gastritis. Dynamic observation of patients included chromoscopy, magnifikatsionnoe endoscopic, endoscopic.Results: Polypoid masses were identified in 151 case (67.4%), flat lesions of the mucous - 62 (27.7%), erosion - 11 (4.9%) (Fig. 4). The most common dysplastic changes of gastric mucosa were observed in the antral - 146 cases (65.2%), rarely in the stomach area and subkardii - 78 (34.8%) cases.Summary: The dynamic observation of patients at risk for the development of gastric lesions preneoplasticheskih allows for timely diagnosis and minimally invasive treatment preneoplasticheskie changes and early cancer of the stomach.