Innovative Gastric Cancer Screening Approach Shows Promising Results in Randomized Controlled Trial

In a groundbreaking randomized controlled trial conducted in Yurihonjo and Nikaho city, Akita Prefecture, researchers have unveiled a new approach to gastric cancer (GC) screening that could revolutionize early detection and treatment outcomes. The study compared the efficacy of two screening methods, Ba-Endo (barium photofluorography following upper gastrointestinal endoscopy) and ABC-Endo group (upper gastrointestinal endoscopy according to serological stratification) and found that gastric cancers could be better cured by endoscopic resection alone in the ABC-Endo group.

The study results were published in the journal Gastrointestinal Endoscopy.

Attempts have been undertaken to create an endoscopic screening system that integrates serological gastric cancer (GC) risk stratification, specifically the ABC classification, in conjunction with the yearly population-based GC screening using barium. The study, spanning five years and involving 1,206 participants, compared the efficacy of two screening methods: the Ba-Endo group, which underwent annual barium tests followed by detailed endoscopic examinations, and the ABC-Endo group.

The participants were carefully randomized using the minimization method, with sex and age considered as key allocation factors. Over the course of the study, the Ba-Endo group adhered to annual barium tests, while the ABC-Endo group underwent esophagogastroduodenoscopy (EGD) at varying intervals, including Group A (EGD only at entry), Group B (EGD once every 3 years), Group C (EGD once every 2 years), and Group D (EGD every year).

Findings:

• Results from the trial revealed that both groups exhibited a similar overall GC detection rate of 1.9%, with 24 detected GC lesions.
• The Ba-Endo and ABC-Endo groups demonstrated detection rates of 2.0% and 1.8%, respectively, showing no statistically significant differences between them (P=1.0).
• However, a remarkable finding emerged when analyzing the efficacy of endoscopic resection in treating the detected GCs.
• Notably, the study found that the rate of GCs cured by endoscopic resection alone was 41.6% in the Ba-Endo group. Surprisingly, the ABC-Endo group displayed a significantly higher rate, reaching 90.9% (P=0.02).
• This groundbreaking outcome suggests that the ABC-Endo approach, which tailors endoscopy intervals based on individual risk factors, holds substantial promise in identifying and successfully treating GCs through less invasive means.

These results could potentially reshape the landscape of gastric cancer screening programs worldwide. The personalized ABC-Endo strategy not only demonstrated comparable detection rates to the traditional Ba-Endo method but also exhibited a clear advantage in terms of successful endoscopic resection, offering patients a less invasive and more effective treatment option for early-stage gastric cancers. Further research and validation are crucial, but the promising outcomes of this trial suggest a step forward in the ongoing fight against gastric cancer.

Further reading: Kusano C, Gotoda T, Ishikawa H, Suzuki S, Ikehara H, Matsuyama Y. Gastric Cancer Detection Rates using Gastrointestinal Endoscopy with Serological Risk Stratification: A Randomized Controlled Trial. Gastrointest Endosc. Published online January 23, 2024. doi: 10.1016/j.gie.2024.01.022