ÖZET
Amaç:
Kılavuzlar, yaygın atrofi/intestinal metaplazisi (İM) olan hastalar için endoskopik sürveyansı önermektedir, ancak antrumla sınırlı İM/atrofisi olan hastalar için takip önerilmemektedir. Bu çalışmada, antrum kısıtlı İM olan hastalarda sürveyans endoskopisinin gerekli olup olmadığını belirlemek için neoplastik lezyon riskini değerlendirdik.
Yöntemler:
Son 10 yıl içinde antrum kısıtlı İM tanısı alan 117 hastaya sürveyans endoskopisi yapıldı. Mide biyopsi örneklerinde İM, atrofi, ve displazi değerlendirildi.
Bulgular:
Çalışmamıza 117 hastayı dahil ettik. Sürveyans endoskopi, İM’nin ilk tanısından sonra medyan (çeyrekler arası aralık) 7,2 (5,9-8,7 yıl) sonra yapıldı. Gözetim endoskopisinde, hastaların %27,4’ü İM grade ilerlemesi gösterirken, %25,6 atrofi ilerlemesi ve %33,3 displazide ilerleme gösterdi. Dört hastada yüksek dereceli displazi ve iki hastada mide kanseri (MK) saptandı. Antrum kısıtlı İM olan hastalarda yıllık MK insidansı %0,17 idi. İM grade ve tipi hastaların sırasıyla %29,9 ve %38,5’inde geriledi. Sürveyans endoskopisinde progresif İM grade, İM tip ve displazisi olan hastaların çoğunluğu OLGA evre 3-4 (sırasıyla; p=0,0001, p=0,008 ve p=0,0001) ve progresif atrofi ve displazili hastaların çoğunluğu OLGİM evre 3-4’e sahipti (her ikisi de; p=0,001).
Sonuç:
Antrumla sınırlı İM’li hastalar neoplastik lezyon gelişimi açısından risk altındadır ve önerilerin aksine endoskopik gözetim gerektirir. Premalign lezyonlar hem ilerleme hem de gerileme gösterebilir. OLGA ve OLGİM’ye dayalı hastaya özel bir gözetim programı uygun olabilir.
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