Malignancy within gastric ulcers: is it worth a relook?

Endoscopic follow-up of gastric ulcers is a complex and often debated issue. Current British Society of Gastroenterology guidelines recommend a repeat oesophagogastroduodenoscopy (OGD) 6–8 weeks after the index procedure in all patients diagnosed with a gastric ulcer. An increased risk of gastric cancer in gastric ulcers which initially appeared macroscopically and histologically benign is proposed as the rationale for endoscopic surveillance. Endoscopy services both nationally in the UK and internationally are under increasing pressure, and it is therefore essential to ensure for both services and for patients that all endoscopic procedures which are performed are appropriate. The purpose of this review is to consider the literature concerning follow-up OGDs for gastric ulcers. At present, no comprehensive review of the substantial volume of literature on this important and clinically relevant subject has previously been performed. Through consideration of nineteen published studies and six published abstracts, the review demonstrates that rates of gastric cancer at follow-up endoscopy were very low and that cases may have been suspected at the index procedure even when histology was negative. It also suggests that adequate biopsy sampling and a careful assessment of the endoscopic appearances of the ulcer are key in making the safest choices for patients and may inform patient selection for follow-up procedures. While the evidence strongly supports a tailored approach to follow-up endoscopy, clinical judgement of individual endoscopists should always remain central to any decision which is made to ensure that patient safety is paramount at all times.