title: Gastric ulcers: malignancy yield and risk stratification for follow-up endoscopy.
abstract: OBJECTIVE
  Malignant change can occur in gastric ulcer but guideline recommendations for follow-endoscopy (FU-OGD) are conflicting. This study aims to determine rate of malignancy and need for follow-up for gastric ulcers.
  
  
  METHODS
  Patients with a first diagnosis of gastric ulcer between January 2012 and September 2013 were studied by analyzing endoscopic assessments, dysplasia, and malignancy yield and the influence of risk factors on the likelihood of benign disease.
  
  
  RESULTS
  In a cohort of 432 patients with gastric ulcer (53 % male, mean age 65 years) dysplasia or neoplasia were found in 27 (19 adenocarcinomas, 2 cases of dysplasia, 5 lymphomas, 1 melanoma; malignancy yield 6 %). Twenty-five (93 %) cases were diagnosed on first biopsy. The cancer yield of FU-OGD after initially benign biopsy was 0.9 %. Binary logistic regression analysis revealed that endoscopically benign appearance (odds ratio 0.004 95 % CI 0 - 0.576; P = 0.029), benign histology on first biopsy (odds ratio 0 95 % CI 0 - 0.39; P = 0.011) and lower number of ulcers (odds ratio 0.22 (95 % CI 0.05 - 0.99); P = 0.049) were independent predictors of benign disease. All dysplastic and neoplastic cases would have been identified by a combination of initial biopsies plus repeat endoscopy with further biopsies for endoscopically suspicious appearances.
  
  
  CONCLUSIONS
  In this large cohort 6 % of gastric ulcers were found to be malignant, highlighting the need for all gastric ulcers to be biopsied. The cancer yield of FU-OGD after benign biopsies was low. We have demonstrated that the combination of benign index histology and no endoscopic suspicion of malignancy can predict benign disease. We recommend that all gastric ulcers to be biopsied. Risk stratification could potentially reduce need for FU-OGD.
authors.affiliation: Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Selinger
authors.affiliation: Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cochrane
authors.affiliation: Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Thanaraj
authors.affiliation: Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Sainsbury
authors.affiliation: Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK.
authors.forename: Venkat
authors.initials: V
authors.lastname: Subramanian
authors.affiliation: Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Everett