Gastric cancer screening in low incidence populations: Position statement of AEG, SEED and SEAP

Gastroenterol Hepatol. 2021 Jan;44(1):67-86. doi: 10.1016/j.gastrohep.2020.08.004. Epub 2020 Oct 24.
[Article in English, Spanish]

Abstract

This positioning document, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Endoscopia Digestiva and the Sociedad Española de Anatomía Patológica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H.pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy.

Keywords: Chronic gastritis; Cribado poblacional; Cáncer gástrico; Cáncer gástrico familiar; Displasia; Dysplasia; Familial gastric cancer; Gastric cancer; Gastritis crónica; Helicobacter pylori; Intestinal metaplasia; Mass screening; Metaplasia intestinal.

Publication types

  • Practice Guideline

MeSH terms

  • Carcinoma in Situ / diagnosis
  • Carcinoma in Situ / surgery
  • Consensus*
  • Delphi Technique
  • Family Health
  • Gastroscopy
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy
  • Humans
  • Incidence
  • Intestines / pathology
  • Mass Screening / methods*
  • Metaplasia / diagnosis
  • Metaplasia / pathology
  • Precancerous Conditions / diagnosis
  • Societies, Medical
  • Spain
  • Stomach Neoplasms / diagnosis*
  • Stomach Neoplasms / epidemiology
  • Stomach Neoplasms / therapy