Mourato M B, Pratas N, Branco Pereira A, Costa Pinto F, Dinis R, Fronteira I, Areia M
NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, LA-REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal.
Unidade Local de Saúde Do Alto Alentejo, Hospital Doutor José Maria Grande, Portalegre, Portugal.
Helicobacter. 2025 Jul-Aug;30(4):e70061. doi: 10.1111/hel.70061.
Gastric cancer remains a major global health concern and is still frequently diagnosed at advanced stages in Western countries. Despite increasing evidence supporting the role of endoscopic screening in intermediate-risk regions such as Portugal, no national program currently exists. This study aimed to evaluate the feasibility, adherence, and diagnostic yield of opportunistic upper endoscopy performed simultaneously with colorectal cancer screening.
We conducted an observational retrospective study including individuals aged 50-74 years scheduled for a screening colonoscopy, who were invited to undergo an additional upper gastrointestinal endoscopy, between February 2023 and February 2025 in two endoscopy units in the Alentejo region of Portugal. Data regarding demographics, endoscopic findings, and histology were collected and analyzed descriptively.
Of 401 individuals invited, 380 (94.8%) accepted and underwent upper endoscopy, and 377 were included in the final analysis. Histological findings included Helicobacter pylori infection (30.8%), chronic atrophic gastritis (36.9%) and intestinal metaplasia (10.1%). Regarding neoplastic lesions, 2 cases (0.5%) of low-grade intraepithelial neoplasia, 3 cases (0.8%) of gastric adenocarcinoma, and 2 cases (0.5%) of gastrointestinal stromal tumors were identified, yielding a total malignancy rate of 1.9%; no early gastric cancers were identified. Colorectal findings included 29.2% precancerous lesions and 3.4% invasive colorectal cancer.
This study confirms that opportunistic upper endoscopic screening, integrated into colorectal cancer-screening programs, is feasible, well accepted, and diagnostically valuable in an intermediate-risk Western population. The high rate of precancerous conditions and malignant lesions detected reinforces the need for structured screening strategies. These results align with international recommendations and provide real-world evidence to support broader implementation in similar healthcare contexts.
ClinicalTrials.gov: NCT06316882.
胃癌仍然是全球主要的健康问题，在西方国家仍经常在晚期被诊断出来。尽管越来越多的证据支持内镜筛查在葡萄牙等中风险地区的作用，但目前尚无国家计划。本研究旨在评估与结直肠癌筛查同时进行的机会性上消化道内镜检查的可行性、依从性和诊断率。
我们进行了一项观察性回顾性研究，纳入了2023年2月至2025年2月期间在葡萄牙阿连特茹地区的两个内镜检查单位计划进行结肠镜筛查的50 - 74岁个体，邀请他们额外接受上消化道内镜检查。收集并描述性分析了有关人口统计学、内镜检查结果和组织学的数据。
在401名受邀个体中，380名（94.8%）接受并进行了上消化道内镜检查，377名被纳入最终分析。组织学检查结果包括幽门螺杆菌感染（30.8%）、慢性萎缩性胃炎（36.9%）和肠化生（10.1%）。关于肿瘤性病变，发现2例（0.5%）低级别上皮内瘤变、3例（0.8%）胃腺癌和2例（0.5%）胃肠道间质瘤，总恶性率为1.9%；未发现早期胃癌。结直肠检查结果包括29.2%的癌前病变和3.4%的浸润性结直肠癌。
本研究证实，将机会性上消化道内镜筛查纳入结直肠癌筛查计划在西方中风险人群中是可行的、易于接受的且具有诊断价值。检测到的癌前疾病和恶性病变的高发生率强化了制定结构化筛查策略的必要性。这些结果与国际建议一致，并提供了真实世界的证据以支持在类似医疗环境中更广泛的实施。
ClinicalTrials.gov：NCT06316882。
