Reassessment of non-visible non-invasive neoplasia on gastric mucosa: Case series from a referral centre

Background and study aims: Unexpected finding of non-invasive neoplasia (NiN) on normal-appearing gastric mucosa at random biopsies constitutes a clinical challenge. We evaluated how frequently non-visible NiN is confirmed in a referral centre. Patients and methods: Over a nine-year period, patients diagnosed with non-visible NiN referred to our tertiary center underwent advanced endoscopy. All macroscopic irregularities identified with High-Definition chromoendoscopy were biopsied. When no lesion was detected, large mapping of gastric mucosa was performed. All histological assessments were performed by an expert pathologist. Results: A total of 60 patients (Females: 55%; Median age: 70 years, range 38–88) were evaluated. All patients underwent one or more gastroscopies. At first endoscopy, the presence of NiN was confirmed in only 3 (5%; 95% CI = 0–10.5) patients in whom visible lesions were removed at endoscopy through Endoscopic Submucosal Dissection. No other cases of NiN were observed at the available follow-up on 22 and 7 patients who underwent a second and third endoscopic control, respectively. Conclusions: Our data found that patients with NiN detected at random gastric biopsies in community hospitals should be referred to a tertiary endoscopy centre to identify the few patients deserving prompt treatment and follow-up.