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Improved endoscopic examination using magnification chromoendoscopy together with non\u2010invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost\u2010effectiveness of a follow\u2010up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> A cohort of patients with lesions as severe as atrophic chronic gastritis were followed\u2010up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost\u2010effectiveness of this follow\u2010up model versus its absence. Transition rates were considered time\u2010independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> A total of 100 patients were successfully followed\u2010up over 3\u2003years. Seven cases of dysplasia were diagnosed during follow\u2010up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio &lt;3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3\u2010yearly basis would cost \u20ac455 per quality\u2010adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost \u20ac1868 per QALY for patients with extensive intestinal metaplasia.<\/jats:p><jats:p><jats:bold>Conclusions:\u2002<\/jats:bold> The follow\u2010up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost\u2010effective if improved accurate endoscopic examination of gastric mucosa together with non\u2010invasive assessment of gastric mucosal status are used to identify individuals at high\u2010risk for development of gastric cancer.<\/jats:p>","DOI":"10.1111\/j.1440-1746.2007.04863.x","type":"journal-article","created":{"date-parts":[[2007,2,7]],"date-time":"2007-02-07T13:41:57Z","timestamp":1170855717000},"page":"1594-1604","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Feasibility and cost\u2010effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow\u2010up of patients with atrophic chronic gastritis and intestinal metaplasia"],"prefix":"10.1111","volume":"22","author":[{"given":"M\u00e1rio","family":"Dinis\u2010Ribeiro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Altamiro","family":"Da Costa\u2010Pereira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Lopes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu\u00eds","family":"Moreira\u2010Dias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,2,7]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(96)00492-3"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19971215)80:12<2333::AID-CNCR15>3.0.CO;2-V"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00008469-200102000-00007"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00008469-199510000-00009"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00008469-199305000-00013"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(03)00570-7"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(01)80577-3"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.41.2.142"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s101200200000"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1005628"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1099-1611(199907\/08)8:4<355::AID-PON401>3.0.CO;2-I"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4011"},{"key":"e_1_2_6_14_2","first-page":"1137","article-title":"Quality of life after curative surgery for gastric cancer. 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