Management of premalignant lesions of gastric cancer: a survey of the main options

applied in European Gastroenterology centres

Research Protocol

Class 16

Porto, 2008/2009Authors: Ana Silva, Andreia Carvalho, Carlos Laranja, Cláudia Leite, Daniel Oliveira, Francisco Silva, Henrique Sousa, Joana Matos, João Cardoso, Luís Vale, Mariana Santiago, Pedro Morais, Renato Ramos, Rui Loureiro, Tatiana Salazar;

Supervisors: Dr. Mário Ribeiro e Dr. Ricardo Santos

Introduction

Introduction

Research question

Aims

Participants and Methods

Expected results

References

Introduction

Yamaoka Y, Kato M, Asaka M. Geographic differences in gastric cancer incidence can be explained by differences between Helicobacter pylori strains. Internal Medicine. 2008; 47: 1077-1083.

Introduction

Research question

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Participants and Methods

Expected results

References

IntroductionPremalignant lesions of gastric cancer:

High mortality and morbidity Absence of consensus in terms of diagnosis and

treatment

Lack of guidelines

Yamaoka Y, Kato M, Asaka M. Geographic differences in gastric cancer incidence can be explained by differences between Helicobacter pylori strains. Internal Medicine. 2008; 47: 1077-1083.

Introduction

Research question

Aims

Participants and Methods

Expected results

References

Research question

Which are the main options for diagnosis and treatment of premalignant lesions of gastric cancer that are being taken at an European level?

Introduction

Research question

Aims

Participants and Methods

Expected results

References

Aims• Identify options in terms of diagnosis

of the premalignant lesions of gastric cancer that are being taken at an European level

• Identify options in terms of treatment of the premalignant lesions of gastric cancer that are being taken at an European level

• Compile these management options in a database

Introduction

Research question

Aims

Participants and Methods

Expected results

References

Study Design

• Type of study: observational and cross-sectional

• Participants’ selection• Data collection• Statistical analysis of data• Discussion about expected

results

Introduction

Research question

Aims

Participants and Methods

Expected results

References

Study Participants

Introduction

Research question

Aims

Participants and Methods

Expected results

References

• Target population: - all European Gastroenterology centres

• Sample: - Selection of the centres included by two

ways: 1st: list of the Gastroenterology societies of different

countries from ESG site;2nd: centres involved in the publication of papers on

this subject

non-randomized sample

Data Collection Methods

Introduction

Research question

Aims

Participants and Methods

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Questionnaire

Sent by e-mail

Open ended questions

Closed ended questions

Backup plan: phone interview

Online Database

Variables Description / Planned Statistical Analysis

Introduction

Research question

Aims

Participants and Methods

Expected results

References

• Dependent variables:– Management options taken– Follow-up of patients

• Independent variables:– Type of lesions– Centre– Geographical location– etc

hypothesis test

Creation of guidelines

European Practice Protocol

Phases:1. Contacts’ database

considerable number of centres’ contacts

2. Questionnaire’ s answers

low response rate3. Management options’ database

the most frequently used options

Expected Results

Introduction

Research question

Aims

Participants and Methods

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Expected Results Problems and limitations:

• low response rate from the countries’ societies;

• refusal from some centres to take part in our study;

• refusal from some centres to answer some questions;

• selection bias – societies may give us only the contacts of the centres with positive results in the management of those lesions or from those that are in the forefront of the techniques used in their diagnosis and treatment;

• possibility of obtaining data referring to only one country, or data from very few countries to take conclusions at an European level.

Introduction

Research question

Aims

Participants and Methods

Expected results

References

References• [1] Lockead P, El-Omar EM. Gastric Cancer. Br Med Bull. 2008;85:87-100.• [2] Parkin DM, Bray F, Ferlay J, Pisani P..Global cancer statistics, 2002. CA Cancer J

Clin. 2005 Mar-Apr;55(2):74-108.• [3] Stomach (Gastric) Cancer [Internet]. Bethesda: National Cancer Institute.

Estimated new cases and deaths from stomach cancer in the United States in 2008; [cited 2008 November 1]; [1 screen]. Available from: http://www.cancer.gov/cancertopics/types/stomach

• 4] Plano Nacional de Prevenção e Controlo das Doenças Oncológicas 2007/2010, Dezembro 2007.

• [5] Sugiyama T, Asaka M. Helicobacter pylori infection and gastric cancer. Med Electron Microsc. 2004 Sep;37(3):149-57.

• [6] Menaker RJ, Sharaf AA, Jones NL. Helicobacter pylori infection and gastric cancer: host, bug, environment, or all three?. Curr Gastroenterol Rep. 2004 Dec;6(6):429-35.

• [7] de Vries AC, Haringsma J, Kuipers EJ. The detection, surveillance and treatment of premalignat gastric lesions related to Helicobacter pylori infection. Helicobacter 2007; 12: 1-15.

• [8] Bowles MJ, Benjamin IS. ABC of the upper gastrointestinal tract. Cancer of the stomach and pancreas. BMJ 2001;323:1413–6

• [9] Witold Bartnik. Clinical aspects of Helicobacter pylori infection. Pol Arch Med Wewn, 2008; 118 (7-8): 426-430

• [10] M Dinis-Ribeiro, A Costa-Pereira, C Lopes, L Moreira-Dias. Guidelines for surveillance of patients with atrophic chronic gastritis and intestinal metaplasia in stomach would be welcome! Helicobacter . 2007 Feb;12(1):1-15

Introduction

Research question

Aims

Participants and Methods

Expected results

References