1. Class 16 Porto, 2008/2009 Professor Doutor Altamiro da Costa Pereira Authors: Ana Silva, Andreia Carvalho, Carlos Laranja, Cláudia Leite, Daniel Oliveira, Francisco Silva, Henrique Sousa, Joana Matos, João Cardoso, Luís Vale, Mariana Santiago, Pedro Morais, Renato Ramos, Rui Loureiro, Tatiana Salazar; Supervisors: Prof. Doutor Mário Ribeiro e Dr. Ricardo Santos

2. INTRODUCTION RESEARCH QUESTION PARTICIPANTS AND METHODS Management of premalignant lesions of gastric cancer RESULTS REFERENCES AIMS DISCUSSION

3. Premalignant lesions Gastric Cancer High mortality and morbidity Lack of practical recommendations Worldwide incidence INTRODUCTION Management of premalignant lesions of gastric cancer

4. Premalignant lesions Atrophic chronic gastritis (ACG) Intestinal metaplasia (IM) Dysplasia (Dys) Management of premalignant lesions of gastric cancer INTRODUCTION

5. Which are the main options concerning diagnosis, monitoring and treatment of premalignant lesions of gastric cancer that are being taken by European Gastroenterologists? Management of premalignant lesions of gastric cancer RESEARCH QUESTION

6. Management of premalignant lesions of gastric cancer To assess the clinical practice in terms of diagnosis, monitoring and treatment of premalignant lesions of gastric cancer To compile these management options into a database AIMS

7. Management of premalignant lesions of gastric cancer PARTICIPANTS AND METHODS Type of study Observational Cross-sectional Quantitative

8. Non-randomized sampling Management of premalignant lesions of gastric cancer Target Population: Gastroenterologists performing research in this field Articles search Authors’ contacts database Participants’ selection PARTICIPANTS AND METHODS

9. Management of premalignant lesions of gastric cancer PARTICIPANTS AND METHODS Inclusion Criteria European Author/Centre (when in doubt where included) Published between 2007 – 2009 Keywords: intestinal neoplasm, precancerous conditions, adenocarcinoma, atrophic gastritis, metaplasia

10. Management of premalignant lesions of gastric cancer PARTICIPANTS AND METHODS Link sent by E-mail Link sent by E-mail Open-ended questions Closed-ended questions Data collection Online Questionnaire

11. Dependent variables: –Management options takenManagement options taken Independent variables: –Type of lesionsType of lesions –Author/DepartmentAuthor/Department –Place of workPlace of work –Time of follow-upTime of follow-up –How frequently techniques are appliedHow frequently techniques are applied –Diagnosis of H.P.Diagnosis of H.P. –Eradication of H.P.Eradication of H.P. Management of premalignant lesions of gastric cancer PARTICIPANTS AND METHODS Variables description

12. RESULTS Management of premalignant lesions of gastric cancer Table1: E-mails response E-mails sent E-mails not delivered Researchers who couldn’t answer the questionnaire Responses to the questionnaire Response Rate 1 st time sent 132021410,6% 2 nd time sent 12014321,6% 16 12,2%

13. Management of premalignant lesions of gastric cancer 0 - Do your answers reflect your own practice or your department(s)? RESULTS – Participants description Graph1

14. Management of premalignant lesions of gastric cancer RESULTS – Participants description Graph 2

15. Management of premalignant lesions of gastric cancer RESULTS Graph 3 Graph 4

16. Management of premalignant lesions of gastric cancer RESULTS Graph 5 Graph 6

17. Management of premalignant lesions of gastric cancer RESULTS Graph 7

18. RESULTS Management of premalignant lesions of gastric cancer Graph 8

19. Management of premalignant lesions of gastric cancer RESULTS Graph 9

20. Management of premalignant lesions of gastric cancer RESULTS Graph 10

21. Management of premalignant lesions of gastric cancer RESULTS Graph 11

22. Low response rate we have 12.12% of response Not all questions were answered (missing) Possible Selection Bias -Only sent our questionnaire to practitioners who published papers Management of premalignant lesions of gastric cancer DISCUSSION Problems and limitations Low significance/precision Hard to make generalizations - Results don’t allow for guidelines to be created

23. Management of premalignant lesions of gastric cancer DISCUSSION Results of this study reflect some lack of consensus: disagreement about what is the best sort of follow- up for patients with IM or ACG techniques that should be used for the diagnosis of these lesions

24. However, some tendencies can be identified: diagnose H. pylori in patients with IM, ACG and Dys eradicate the bacteria when it is diagnosed for patients with dysplasia (both low and high grade) is to perform periodical endoscopies even if the patient is asymptomatic. Management of premalignant lesions of gastric cancer DISCUSSION

25. Management of premalignant lesions of gastric cancer 1. Contacts database 2.Answers to questionnaire 3. Management options database 4. Online publication - Build webpage - Software: MS Frontpage RESULTS

26. [1] Lockead P, El-Omar EM. Gastric Cancer. Br Med Bull. 2008;85:87-100. [2] Parkin DM, Bray F, Ferlay J, Pisani P..Global cancer statistics, 2002. CA Cancer J Clin. 2005 Mar-Apr;55(2):74- 108.. [3] Stomach (Gastric) Cancer [Internet]. Bethesda: National Cancer Institute. Estimated new cases and deaths from stomach cancer in the United States in 2008; [cited 2008 November 1]; [1 screen]. Available from: http://www.cancer.gov/cancertopics/types/stomach 4] Plano Nacional de Prevenção e Controlo das Doenças Oncológicas 2007/2010, Dezembro 2007. [5] Sugiyama T, Asaka M. Helicobacter pylori infection and gastric cancer. Med Electron Microsc. 2004 Sep;37(3):149-57. [6] Menaker RJ, Sharaf AA, Jones NL. Helicobacter pylori infection and gastric cancer: host, bug, environment, or all three?. Curr Gastroenterol Rep. 2004 Dec;6(6):429-35. [7] de Vries AC, Haringsma J, Kuipers EJ. The detection, surveillance and treatment of premalignat gastric lesions related to Helicobacter pylori infection. Helicobacter 2007; 12: 1-15. [8] Bowles MJ, Benjamin IS. ABC of the upper gastrointestinal tract. Cancer of the stomach and pancreas. BMJ 2001;323:1413–6 [9] Witold Bartnik. Clinical aspects of Helicobacter pylori infection. Pol Arch Med Wewn, 2008; 118 (7-8): 426- 430 [10] M Dinis-Ribeiro, A Costa-Pereira, C Lopes, L Moreira-Dias. Guidelines for surveillance of patients with atrophic chronic gastritis and intestinal metaplasia in stomach would be welcome! Helicobacter. 2007 Feb;12(1):1-15 Management of premalignant lesions of gastric cancer REFERENCES

27. Management of premalignant lesions of gastric cancer ACKNOWLEDGEMENTS Eng.º Jorge Jácome Prof. Doutor Altamiro da Costa Pereira Prof. Doutor Mário Dinis Ribeiro Dr. Ricardo Santos