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

Abstract

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. 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. 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.