Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score

Background Surveillance after gastric endoscopic submucosal dissection ( ESD) is recommended for all patients owing to the persistent risk of metachronous gastric lesions (MGLs). We developed and validated a prediction score to estimate MGL risk after ESD for early neoplastic gastric lesions, to define an individualized and cost-saving approach. Methods Clinical predictors and a risk score were derived from meta-analysis data. A retrospective, single- center, cohort study including patients with >= 3 years of standardized surveillance after ESD was conducted for score validation. Predictive accuracy of the score by the area under the receiver operating characteristic curve (AUC) was assessed and cumulative probabilities of MGL were estimated. Results The risk score (0-9 points) included six clinical predictors (scored 0-3): positive family history of gastric cancer, older age, male sex, corpus intestinal metaplasia, synchronous gastric lesions, and persistent Helicobacter pylori infection (FAMISH). The study population included 263 patients. The MGL rate was 16 %. The score diagnostic accuracy for predicting MGL at 3 years' follow-up, measured by the AUC, was 0.704 (95 %CI 0.603-0.806). At 3 years and a cutoff < 2, the score achieved maximal sensitivity and negative predictive value; 15% of patients could be assigned to a low- risk group, in which the progression to MGL was significantly lower than for the high- risk group ( P = 0.04). Conclusion The FAMISH score might be a useful tool to accurately identify patients with low-to-intermediate risk for MGL at 3 years of follow-up who could have surveillance intervals extended to reduce the burden of care.

Automated summary

Surveillance after gastric endoscopic submucosal dissection (ESD) is recommended for all patients to monitor the risk of metachronous gastric lesions (MGLs). A prediction score, derived from clinical predictors, has been developed and validated to estimate MGL risk after ESD for early neoplastic gastric lesions, providing an individualized and cost-saving approach.