Subtype-specific risk factors for gastric adenomas and independent predictors of recurrence after endoscopic resection

Table 1 Patients’ baseline characteristics (n = 79), mean ± SD

	n (%)
Gender
Male	51 (64.6)
Female	28 (35.4)
Mean age, years	68.1 ± 14.6
Mean BMI, kg/m2	24.9 ± 3.9
Comorbidities
Cardiovascular diseases	46 (58.2)
Malignancy	22 (27.8)
Diabetes	17 (21.5)
Chronic kidney disease	4 (5.1)
Morbid obesity	3 (3.8)
Cirrhosis	2 (2.5)
History of PPI intake	75 (94.9)
History of NSAID/Aspirin intake	54 (68.4)
History of alcohol abuse	39 (49.4)
History of smoking	34 (43.0)
History of statin intake	26 (32.9)
Hereditary predisposition
FAP	4 (5.1)
Peutz Jeghers/juvenile polyposis	2 (2.5)
Others	2 (2.5)
Personal history of gastric neoplasia
Adenocarcinoma	14 (17.7)
Adenoma	7 (8.9)
Family history
Gastric adenocarcinoma	8 (10.1)
Colorectal cancer	5 (6.3)
Other cancers	3 (3.8)

BMI: Body mass index; NSAID: Nonsteroidal anti-inflammatory drug; PPI: Proton pump inhibitor; FAP: Familial adenomatous polyposis.

Table 2 Baseline endoscopic and histopathological characteristics (n = 79), mean ± SD

	n (%)
Baseline endoscopic characteristics:
Number of lesions
1/2/≥ 3	68 (86.1)/5 (6.3)/6 (7.6)
Mean size, mm	31.9 ± 19.2
Location
Cardia/fundus	21 (26.6)
Greater curvature	18 (22.8)
Lesser curvature	8 (10.1)
Antrum	29 (36.7)
Pylorus	3 (3.8)
Gross morphology (Paris classification)
0-Ip	10 (12.7)
0-Is	17 (21.5)
0-IIa	22 (27.8)
0-IIb	2 (2.5)
0-IIc	6 (7.6)
0-IIa+IIc	20 (25.4)
0-Is+IIc	2 (2.5)
Color
Reddish	41 (51.9)
Same as background mucosa	20 (25.3)
Ulcerated/erosive	16 (20.3)
Whitish	2 (2.5)
Treatment
EMR	14 (17.7)
ESD	65 (82.3)
Histopathological characteristics:
Histological subtype
Intestinal	49 (62.0)
Foveolar	23 (29.1)
Pyloric	6 (7.6)
Oxyntic	1 (1.3)
Helicobacter pylori infection
Negative	56 (70.9)
Past infection	18 (22.8)
Current infection	4 (5.1)
Mean size of resected specimen, mm	37.7 ± 34.3
Underlying stomach
Normal	11 (13.9)
Atrophic gastritis	39 (49.4)
Intestinal metaplasia	29 (36.7)
Worst histology
LGD	22 (27.8)
HGD	18 (22.8)
Intramucosal adenocarcinoma (T1a)	21 (26.6)
Submucosal carcinoma (T1b)	18 (22.8)
Resection completeness
Histologically complete (R0)	73 (92.4)
Piecemeal	5 (6.3)
Failed endoscopic resection	1 (1.3)

EMR: Endoscopic submucosal resection; ESD: Endoscopic submucosal dissection; LGD: Low-grade dysplasia; HGD: High grade dysplasia.

Table 3 Clinical and endoscopic outcomes (n = 79)

	n (%)
Mean follow-up, months, mean ± SD	26.3 ± 21.8
Early follow-up (3-6 months)
Residual adenoma	4 (5.1)
Management of residual adenoma
EMR	2 (2.5)
ESD	2 (2.5)
Late follow up (> 6 months)
Mean time to recurrence ± SD, months	18.0 ± 15
Recurrent adenoma
Local	9 (11.4)
Metachronous	1 (1.3)
Management of recurrent adenoma
EMR	6 (7.6)
ESD	4 (5.1)
Pathology of recurrent adenoma
LGD	7 (8.9)
HGD	2 (2.5)
Intramucosal adenocarcinoma (T1a)	1 (1.3)

EMR: Endoscopic submucosal resection; ESD: Endoscopic submucosal dissection; LGD: Low-grade dysplasia; HGD: High grade dysplasia.

Table 4 Clinical, endoscopic and histopathological characteristics of different gastric adenoma subtypes, mean ± SD

	Intestinal (n = 49) (%)	Foveolar (n = 23) (%)	Pyloric (n = 6) (%)	P value
Patients characteristics:
Gender (male)	69.40	65.20	33	0.215
Mean age, years	71.1 ± 12.9	63.8 ± 15.7	58.2 ± 17.9	0.031
Mean BMI, kg/m2	25.3 ± 3.2	24.1 ± 4.8	25.2 ± 6.2	0.564
Comorbidities
Diabetes	22.40	21.70	16.70	0.94
Cardiovascular diseases	55.10	73.90	33.30	0.142
Morbid obesity	6.10	0.00	0.00	0.389
Malignancy	24.50	30.40	50.00	0.43
Chronic kidney disease	6.10	4.30	0.00	0.79
Cirrhosis	2.00	0.00	16.70	0.069
History of PPI intake	91.80	100	100.00	0.531
History of NSAID/Aspirin	65.30	82.60	33.30	0.046
History of statin	38.80	26.10	0.00	0.04
Hereditary predisposition
FAP	2.00	8.70	16.70	0.106
Juvenile polyposis	0.00	8.70	0.00
Personal history				0.106
Gastric neoplasia
Adenocarcinoma	22.40	4.30	33.30
Adenoma	4.10	13	33.30
Family history				0.006
Gastric adenocarcinoma	14.30	4.30	0
Colorectal cancer	6.10	8.70	0
Other cancers	0	4.30	33.30
Baseline endoscopic findings:
Number of lesions				< 0.001
1/2/≥ 3	93.9/6.1/0	78.3/0/21.7	66.7/33.3/ 0
Mean size, mm	27.5 ± 14.6	34.6 ± 18.1	59.2 ± 33.2	< 0.001
Location				0.048
Cardia/Fundus	24.50	30.40	33.30
Greater curvature	14.30	34.80	33.30
Lesser curvature	8.20	17.40	0.00
Antrum	48.90	17.40	16.70
Pylorus	4.10	0.00	16.70
Gross morphology				0.046
(Paris classification)
0-Ip	2.00	26.10	33.30
0-Is	18.40	21.70	50.00
0-IIa	32.70	21.70	16.70
0-IIb	4.10	0.00	0.00
0-IIc	10.20	4.30	0.00
0-IIa+IIc	28.60	26.10	0.00
0-Is+IIc	4.10	0.00	0.00
Color				0.269
Same as background mucosa	32.70	17.40	0.00
Whitish	2.00	4.30	0.00
Reddish	42.90	60.90	83.30
Ulcerated/Erosive	22.40	17.40	16.70
Treatments
EMR/ESD	6.1/93.9	34.8/65.2	33.3/66.7	0.005
Histological characteristics:
Active Helicobacter pylori	4.10	8.70	0.00	0.373
Underlying stomach
Atrophic gastritis	67.30	13	50	< 0.001
Intestinal metaplasia	26.50	69.60	0.00
Worst histology				0.411
LGD	20.40	30.40	50
HGD	18.40	26.10	33.30
Early gastric adenocarcinoma	57.10	43.50	16.70
T1a	34.70	17.40	0.00
T1b	22.40	26.10	16.70
Mean size of resected specimen, mm	34.1 ± 14.0	47.0 ± 58.0	35.0 ± 23.0	0.349
Histologically complete resection (R0)	89.80	91.30	100	0.935
Clinical outcomes:
Mean follow-up, months	24.9 ± 21.9	26.3 ± 21.4	43.1 ± 27.1	0.613
Early follow-up
Residual adenoma	2.00	13.00	0.00	0.184
Management: EMR/ESD	0.0/2.0	8.7/4.3	0.0/0.0	0.205
Late follow up (recurrence)
Mean time to recurrence, months	21.4 ± 16.8	19.9 ± 17.3	14.3	0.833
Local/metachronous	6.1/2.0	17.4/0.0	16.7/0.0	0.07
Management: EMR/ESD	2.0/6	17.4/0.0	0.0/16.7	0.044
Pathology				0.284
LGD	2.00	17.40	16.70
HGD	4.10	0.00	0.00
T1a	2.00	0.00	0.00

BMI: Body mass index; NSAID: Non steroidal anti-inflamatory drugs; PPI: Proton puump inhibitors; FAP: Familial adenomatous polyposis; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; LGD: Low grade dysplesia; HGD: High grade dysplesia.

Table 5 Potential risk factors for different subtypes of gastric adenomas and independent predictors for recurrence after endoscopic resection

	B-estimate	P value	Odds ratio	95%CI
Potential risk factors for different subtypes of gastric adenomas
Intestinal adenoma:
Age ≥ 65 years	1.171	0.021	3.224	(1.198-4.680)
History of statin intake	0.149	< 0.001	1.161	(1.1-3.255)
Family history of gastric adenocarcinoma	0.495	< 0.001	1.641	(1.38-3.995)
Single polyp	0.551	< 0.001	1.736	(1.47-4.163)
Antrum as location	0.861	< 0.001	2.366	(2.06-5.235)
Atrophic gastritis	0.605	< 0.001	1.831	(1.56-4.329)
Morphology as Paris classification 0-IIa	0.758	< 0.001	2.134	(1.84-4.848)
Foveolar adenoma:
BMI ≥ 28 kg/m2	0.105	< 0.001	1.111	(1.03-3.656)
History of NSAID intake	0.623	< 0.001	1.864	(1.59-4.387)
Morphology as Paris classification 0-IIa	0.927	0.048	2.528	(2.21-5.501)
Intestinal metaplasia	0.513	< 0.001	1.671	(1.41-4.048)
Pyloric adenoma:
BMI ≥ 28 kg/m2	0.442	< 0.001	1.560	(1.26-6.152)
Largest polyp size ≥ 30 mm	0.712	< 0.001	2.039	(1.34-5.11)
Multiple polyps	0.870	< 0.001	2.386	(2.08-5.268)
Morphology as Paris classification 0-Ip	0.863	0.001	2.370	(2.06-5.242)
Independent predictors for recurrence after endoscopic resection
Family history of gastric adenocarcinoma	0.287	< 0.001	1.332	(1.1-3.431)
Largest polyp size ≥ 30 mm	0.714	< 0.001	2.042	(1.76-4.692)
Number of polyps > 3	0.411	< 0.001	1.509	(1.26-3.757)
Lesser curvature as location	0.542	< 0.001	1.720	(1.46-4.135)
Morphology as Paris classification 0-IIc	0.127	< 0.001	1.135	(1.092-3.055)
Active Helicobacter pylori infection	0.139	< 0.001	1.149	(1.019-3.083)

BMI: Body mass index; NSAID: Non steroidal anti-inflamatory drugs.