Predicting Gastric Neoplasia in Patients with High-risk Endoscopic Features

• Patients at high risk for gastric cancer are undergone screening esophagogastroduodenoscopy at the Endoscopy department of Gastrointestinal endoscopy center of Huadong hospital affiliated to Fudan University.
• For every enrolled patient, follow-up esophagogastroduodenoscopy were conducted in the 3rd and 5th years after the baseline examination. If high-risk endoscopic features for gastric cancer (i.e., active Helicobacter pylori infection or atrophic gastritis classified as C2-O3 according to the Kimura-Takemoto classification) were observed during the baseline examination, an additional follow-up esophagogastroduodenoscopy was performed in the 1st year after the baseline examination.
• Clinical characteristics, gastric neoplasia-related blood biomarkers, the extent of atrophic gastritis and other endoscopic findings were collected in baseline and follow-up esophagogastroduodenoscopy. For patients whose baseline esophagogastroduodenoscopy indicates open-type atrophic gastritis (Kimura-Takemoto classification O1-O3), blood samples will be collected for whole-genome sequencing at the time of the baseline and the final follow-up examination.
• Enrolled patients were followed up until gastric neoplasia was detected, up to a maximum of 5 years.
• After the study was completed, a prediction model for predicting gastric neoplasia in patients with atrophic gastritis was developed.

Inclusion criteria

• Age ≥ 45 years
• Meets the definition of a high-risk population for gastric cancer, which includes one or more of the following: (1) Residence in a high-incidence region for gastric cancer (2) Helicobacter pylori (Hp) infection (3) History of chronic atrophic gastritis, gastric ulcer, gastric polyps, post-gastrectomy status, hypertrophic gastritis, pernicious anemia, or other precancerous gastric conditions (4) First-degree relatives of patients with gastric cancer (5) Other risk factors for gastric cancer such as high salt intake, frequent consumption of pickled foods, smoking, or heavy alcohol use
• No gastric cancer or precancerous lesions detected on initial esophagogastroduodenoscopy, yet with endoscopic features consistent with high-risk endoscopic features. High-risk endoscopic include: (1) Active Helicobacter pylori infection (2) Atrophic gastritis (Kimura-Takemoto classification C1-O3)
• Provision of written informed consent and agreement to comply with the follow-up requirements specified in the study protocol

Exclusion criteria

• Emergency esophagogastroduodenoscopy
• History of partial or total gastrectomy
• ASA physical status classification of 3 or higher
• Use of oral antiplatelet or anticoagulant medications, or coagulopathy (defined as a platelet count < 50 × 10^9/L or INR > 1.5)
• Pregnancy or lactation
• Severe cardiac, pulmonary, hepatic, or renal disease
• Concomitant other malignant tumors or severe infectious diseases
• Refusal to sign the informed consent form or any other condition deemed unsuitable for study participation