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Diagnosis and Management of Epithelial Precancerous Conditions and Lesions in the Stomach

  • Endoscopy (P Siersema, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer risk and guidelines recommend endoscopic surveillance, as diagnosis of early gastric neoplasia allows endoscopic resection. This review summarizes the current approach to the diagnosis and surveillance of pre-malignant gastric conditions and endoscopic treatment of early gastric cancer.

Recent findings

Virtual chromoendoscopy can diagnose extensive gastric metaplasia with great accuracy compared with histopathology and higher endoscopic staging is a risk factor for gastric cancer. Poorly differentiated and superficially invasive cancers have higher (up to 3%) lymph node metastasis risk even after curative resection, which should influence post-resection management. After non-curative resection, a histopathological score (eCura system) can predict LNM and survival without gastrectomy.

Summary

Extensive pre-malignant gastric conditions should be surveilled with high-definition chromoendoscopy, which allows intestinal metaplasia staging and improves dysplasia diagnosis. Endoscopic submucosal dissection is well-established as the first-line treatment of early gastric cancer.

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Authors and Affiliations

  1. Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal

    Inês Pita MD, Diogo Libânio MD, PhD & Pedro Pimentel Nunes MD, PhD

  2. MEDCIDS-Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal

    Diogo Libânio MD, PhD & Pedro Pimentel Nunes MD, PhD

  3. Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal

    Pedro Pimentel Nunes MD, PhD

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  1. Inês Pita MD
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  2. Diogo Libânio MD, PhD
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Inês Pita, Pedro Pimentel Nunes, and Diogo Libânio declare no conflict of interest.

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Pita, I., Libânio, D. & Nunes, P.P. Diagnosis and Management of Epithelial Precancerous Conditions and Lesions in the Stomach. Curr Treat Options Gastro 19, 277–294 (2021). https://doi.org/10.1007/s11938-021-00341-2

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