TBA (26S168)

Feasibility of Screening Gastroscopy to Prevent Gastric Cancer: Irish Data From TOGAS Pilot 2

Author(s)

Casey, Orlaith (1,2), Deane, Charlene (1,2), Hegarty, Cormac(1), Costigan, Conor (1,3), Semenov, Serhiy (1), Nally, Fionn (1), Hazel, Karl (1,2), O’Morain, Colm(3), Kelly, Orlaith (1,2)

Department(s)/Institutions

1. Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin 2. School of Medicine, Royal College of Surgeons of Ireland 3. School of Medicine, Trinity College Dublin

Introduction

TOGAS is a large EU-funded study providing preliminary data to inform implementation of gastric cancer screening across Europe. “Pilot 2” focuses on participants aged 50-74 years-old undergoing FIT-positive/surveillance colonoscopy. Those patients are offered gastroscopy at the time of scheduled colonoscopy to determine prevalence of precancerous lesions, e.g., intestinal metaplasia (IM) and gastric atrophy, Helicobacter pylori infection and gastric cancer.

Aims/Background

Primary aim to determine feasibility of implementing gastric cancer screening by combined approach including both upper and lower endoscopy at time of FIT-positive/surveillance colonoscopy. Secondary outcomes include the prevalence of precancerous stomach lesions, H. pylori and gastric cancer in an Irish population.

Method

All patients attending BowelScreen Centre between September 2024-February 2026 for NCSS/surveillance colonoscopy aged 50-74-years-old were screened. Eligible patients were offered additional gastroscopy. Gastroscopy per study protocol with 12 stomach images, Sydney protocol biopsies and CLO test. The incidence of precancerous stomach lesions, H. pylori and cancer were recorded in 112 gastroscopies. Colonoscopy outcomes were also noted.

Results

Median age was 66, IQR 7.25 years. 59 (52.68%) were male. Indications included NCSS (57.14%), screening (no FIT) (26.79%), previous polyps/surgery (14.29%) or family history (4.46%). Acceptance rate of all invitations was 68.52%. 13.39% were found to have IM, 4 of whom had OLGIM scores ≥3, requiring surveillance. One participant had gastric atrophy. 23 participants were H. pylori positive, 56.52% of whom had a positive CLO test. 9 cases of Barrett’s oesophagus requiring surveillance were identified. One gastro-oesophageal junction adenocarcinoma was found.

Conclusions

Endoscopy is a feasible screening tool pending cost-benefit and patient acceptability analyses. H. pylori is prevalent in our study population as is IM and would be considered intermediate risk for gastric cancer. These findings highlight the need for a population-based gastric cancer screening programme.