Risk stratifying gastric ulcers: development and validation of a scoring system

Area of Science:

• Gastroenterology
• Oncology
• Medical Diagnostics

Background:

• The necessity of routine endoscopic follow-up for gastric ulcer healing remains debated.
• Accurate risk stratification is crucial for optimizing patient management and resource allocation.

Purpose of the Study:

• To evaluate the utility of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing.
• To develop and validate a risk score for stratifying patients based on malignancy risk.

Main Methods:

• Retrospective analysis of patients diagnosed with gastric ulcers undergoing index OGDs.
• Logistic regression was used to identify factors associated with malignancy and derive a risk score.
• External validation of the derived risk score was performed.

Main Results:

• Older age, larger ulcer size, and non-antral location were significantly associated with malignancy.
• The derived risk score demonstrated high accuracy (AUC 0.868, validated AUC 0.862) in distinguishing between benign and malignant ulcers.
• A low risk score combined with benign ulcer appearance and negative biopsies showed a high negative predictive value (NPV 97.4%, validated NPV 98.6%) for malignancy.

Conclusions:

• Patients with macroscopically benign gastric ulcers, negative biopsies, and a low-risk score may not require routine endoscopic follow-up.
• The developed risk score aids in identifying patients who can safely forgo follow-up OGDs, thereby improving efficiency in gastric ulcer management.