Treatment Of Gastric Dysplasia Research Articles

Clinical outcomes of ablation of gastric dysplasia with argon plasma coagulation.

Although several small cohort studies have shown the utility of argon plasma coagulation (APC) in the treatment of gastric dysplasia, its clinical significance has not been established. This study aims to assess the efficacy of APC as a first line treatment for gastric dysplasia, and identify risk factors for residual dysplasia. A total of 179 cases of gastric dysplasia were treated with APC and have been followed-up with upper endoscopy within 1 year. The overall incidence and the characteristics of lesions with residual dysplasia in follow-up endoscopy were analyzed by logistic regression. Among 179 lesions treated with APC, 171 (95.5%) lesions have achieved complete ablation in the follow-up endoscopy. Additional APC was applied for residual dysplasia, achieving complete ablation in 97.77% (175/179). The upper third location of the gastric dysplasia was significantly associated with residual dysplasia, while tumor size, horizontal location, macroscopic morphology and grade of dysplasia showed no significant associations with residual dysplasia following the initial APC. APC with meticulous follow-up can be recommended as a first line treatment in patients with gastric dysplasia.

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold.

Gastric cancer accounts for a significant proportion of worldwide cancer-related morbidity and mortality. The well documented precancerous cascade provides an opportunity for clinicians to detect and treat gastric cancers at an endoscopically curable stage. In high prevalence regions such as Japan and Korea, this has led to the implementation of population screening programs. However, guidelines remain ambiguous in lower prevalence regions. In recent years, there have been many advances in the endoscopic diagnosis and treatment of early gastric cancer and precancerous lesions. More advanced endoscopic imaging has led to improved detection and characterization of gastric lesions as well as superior accuracy for delineation of margins prior to resection. In addition, promising early data on artificial intelligence in gastroscopy suggests a future role for this technology in maximizing the yield of advanced endoscopic imaging. Data on endoscopic resection (ER) are particularly robust in Japan and Korea, with high rates of curative ER and markedly reduced procedural morbidity. However, there is a shortage of data in other regions to support the applicability of protocols from these high prevalence countries. Future advances in endoscopic therapeutics will likely lead to further expansion of the current indications for ER, as both technology and proceduralist expertise continue to grow.

Radiofrequency ablation for the treatment of gastric dysplasia

Different endoscopic techniques such as endoscopic mucosal resection, endoscopic submucosal dissection, argon-plasma coagulation, and photodynamic therapy have been used in the treatment of gastric dysplasia. Radiofrequency ablation (RFA) has become a recognized tool in the treatment of dysplastic Barrett's esophagus, but its use in gastric dysplasia has not yet been studied. We aim to describe three cases of RFA treatment in patients with persistent dysplastic gastric mucosa confirmed by consensus of two expert gastrointestinal pathologists. In each patient, two catheter-based RFA procedures were performed 8 weeks apart in an outpatient setting. Although each patient reported minor epigastric pain after RFA, there were no major complications such as bleeding, perforation, stricture, or the need for hospitalization. Endoscopic follow-up with extensive biopsy sampling 2, 4, 6, 12, and 18 months after the last RFA revealed negative results for dysplasia in all patients. These results suggest that RFA may be considered in the treatment of gastric dysplasia. The confirmation of these data with a large series can lead to a change in the paradigm of gastric dysplasia management.