Not every stomach is the same: tailoring dysplastic and early gastric cancer lesions detection

Early detection of gastric dysplastic lesions and early gastric cancer (EGC) is crucial to enable prompt treatments, such as endoscopic submucosal dissection (ESD). Understanding the distribution and characteristics of these lesions can enhance the efficiency of endoscopic examinations. This study aimed to analyze the locations and characteristics of dysplasia and EGCs in the stomach.

Retrospective study reviewing pathologically diagnosed gastric dysplasia and EGCs treated by ESD. Lesions were grouped by location (proximal-cardia, fundus, and body; distal-incisura and antrum) and compared regarding several clinicopathological variables. A predictive model - Search At the Top (SAT) score - was created using three pre-endoscopic variables: male sex (2 points), excessive alcohol consumption (1 point), and smoking (1 point). The score was evaluated for its ability to predict proximal lesions.

A total of 215 patients were included (66.5% male; mean age 68 ± 8 years), with 225 lesions analyzed: 50.7% low-grade dysplasia, 30.7% high-grade dysplasia, and 18.6% adenocarcinoma. Most lesions were located in the distal stomach (73.3%) and along the lesser curvature (39.6%).Proximal lesions were more often associated to male sex (P = 0.001), younger age (P = 0.027), alcohol consumption (P = 0.003), and smoking (P = 0.008).The SAT-score showed moderate discriminative performance (area under the curve = 0.674) and identified high-risk patients (score ≥3) with 3.5-fold increased odds of having proximal lesions (odds ratio = 3.459; P < 0.001).

Most gastric dysplastic lesions and EGCs were located in the distal stomach and along the lesser curvature. Proximal gastric lesions were more frequent in younger male patients with alcohol and tobacco exposure. These location-specific characteristics can enhance the diagnostic performance of endoscopic screening and surveillance, potentially leading to improved patient outcomes.