LAUSR

BACKGROUND AND STUDY AIM Surveillance after gastric endoscopic submucosal dissection (ESD) is recommended for all patients due to the persistent risk of metachronous gastric lesions (MGLs). We aimed to develop and validate a prediction score to estimate MGL risk after ESD for early neoplastic gastric lesions, to define an individualized and cost saving approach. PATIENTS AND METHODS Clinical predictors and a risk score were derived from meta-analysis data. A retrospective, single centre, cohort study including patients with >3 years standardized surveillance after ESD was conducted for score validation. Predictive accuracy of the score by the receiver operating characteristic curve was assessed and cumulative probabilities of MGL were estimated. RESULTS The risk score (0-9 points) included 6 clinical predictors (scored 0-3): positive family history of gastric cancer, older age, male gender, corpus intestinal metaplasia, synchronous gastric lesions and persistent Helicobacter pylori infection. Study population included 263 patients; the MGL rate was 16%. The score diagnostic accuracy for predicting MGL at 3 years of follow-up as measured by the AUC was 0.704 (95% CI 0.603-0.806). At 3 years and a cut-off <2, it achieved maximal sensitivity and negative predictive value; 15% patients could be assigned to a low-risk group, in which the progression to MGL was significantly lower than for the high-risk group (p=0.037). CONCLUSION The FAMISH score might be a concise and useful tool, accurately identifying patients with low-to-intermediate risk for MGL at 3 years of follow-up, who might expand the surveillance interval to reduce the burden of care.