ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-3 Huang Management Surveillance of Gastric Metaplasia

3 Huang Management Surveillance of Gastric Metaplasia

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In this document, Dr. Robert Huang discusses the management and surveillance of gastric metaplasia. Gastric metaplasia is a precursor lesion to gastric cancer and understanding its epidemiology and risk factors is important for early detection and treatment.<br /><br />Gastric cancer is diagnosed later and has worse prognosis in the United States compared to East Asian nations with structured screening programs. Gastric metaplasia is driven by inflammation, primarily due to Helicobacter pylori infection worldwide and autoimmune gastritis in the United States.<br /><br />Diagnosing gastric metaplasia requires thorough endoscopic exams with mucosal cleaning, adequate exam time, and high-resolution endoscopes with narrow band imaging (NBI) capability. NBI imaging has been shown to improve the detection of gastric metaplasia.<br /><br />Histologically, metaplasia can be classified as incomplete or complete based on the presence or absence of a brush border and the size of mucin deposits in goblet cells. Incomplete histology is associated with a higher risk for progression to gastric cancer.<br /><br />H. pylori eradication is recommended in all cases, but it may not eliminate gastric metaplasia completely. Long-term surveillance is necessary for individuals with persistent metaplasia. Risk stratification can be done based on factors such as family history, extension and histologic severity, and histologic phenotype.<br /><br />International guidelines vary in their recommendations for surveillance intervals and screening methods. Shared decision-making with patients is crucial in determining the need for surveillance endoscopies, considering the potential benefits and risks.<br /><br />Overall, the goal is to educate patients about the risks and benefits of surveillance, perform thorough endoscopic exams, and collaborate with pathologists to accurately interpret biopsies. By implementing effective management and surveillance strategies, early detection and treatment of gastric metaplasia can be achieved to reduce the risk of developing gastric cancer.

Keywords

gastric metaplasia

surveillance

gastric cancer

early detection

endoscopic exams

H. pylori infection

risk stratification

histologic severity

surveillance intervals

pathologists