Endoscopic follow-up in patients with first-degree relatives for gastric cancer: a real-world observational study

Background: First-degree family history of gastric cancer is a risk factor for gastric cancer and precancerous conditions, but only a few studies exist regarding the endoscopic follow-up of these patients. This study investigates endoscopic and histological findings over a 15-year period in patients with first-degree relatives of gastric cancer intestinal type who underwent follow-up upper gastrointestinal endoscopies. Research design and methods: We conducted a retrospective real-world observational study involving patients who underwent at least two upper gastrointestinal endoscopies between 2008 and 2023 at Sant’Andrea Hospital, Rome. The study analyzed histological findings, dividing participants into four subgroups based on their baseline conditions [H. pylori infection, gastric atrophy, intestinal metaplasia, dysplasia]. Results: One hundred and six patients were included, only 13% were indicated for follow-up endoscopy according to the MAPS guidelines. An additional 13% of patients developed precancerous conditions, most of whom were H. pylori positive at the index examination, with an odds ratio risk of 6.778 (p = 0.004). Conclusions: Performing routinely virtual chromoendoscopy during the index endoscopy in these patients could improve the detection of precancerous conditions. Special attention should be given to H. pylori-positive patients due to their increased risk of developing precancerous conditions, for whom follow-up endoscopies may be beneficial.