ASGE Annual Postgraduate Course at DDW: UPPER GI Only (On-Demand) | May 2019-5 May_Detection and Treatment of Early Gasric Cancer.pdf

5 May_Detection and Treatment of Early Gasric Cancer.pdf

Pdf Summary

The incidence of gastric cancer has been decreasing slowly over the last few decades, but it still remains a significant cause of cancer death worldwide. Early detection and treatment are crucial for improving outcomes.<br /><br />The precursor for intestinal type gastric adenocarcinoma is intestinal metaplasia (IM). Endoscopic assessment is necessary to identify mucosal changes indicative of atrophy, IM, and dysplasia. Techniques such as white light endoscopy and digital chromoendoscopy can aid in the detection of IM.<br /><br />Surveillance of patients with non-dysplastic IM is not recommended unless other risk factors are present. However, recent European guidelines suggest high-quality endoscopy every 3 years for patients with extensive IM or sooner if there is a family history of gastric cancer.<br /><br />Screening programs for IM and gastric cancer are well-established in Asia but not recommended in North America. A recent study suggests that screening in high-risk populations in North America may be cost-effective, but not in non-Hispanic whites.<br /><br />Endoscopic treatment is appropriate when the mucosal lesion can be fully resected (R0) with minimal risk of lymph node involvement. The risk of lymph node metastasis depends on the size and depth of the lesion.<br /><br />For resection of early gastric lesions, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the two main techniques. ESD allows for en-bloc resections and is preferred for lesions of any size.<br /><br />After resection, patients should undergo regular surveillance due to the high risk of metachronous lesions. This includes endoscopic examinations at regular intervals and, in some cases, CT scans.<br /><br />Overall, careful endoscopic assessment, surveillance of high-risk populations, and appropriate use of endoscopic treatments can contribute to the detection and treatment of early gastric cancer. ESD is the preferred method of endoscopic treatment, but EMR may be suitable for small lesions.

Keywords

gastric cancer

cancer death

early detection

intestinal metaplasia

endoscopic assessment

white light endoscopy

digital chromoendoscopy

surveillance

screening programs

endoscopic treatment