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

3 Huang Management Surveillance of Gastric Metaplasia

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This document provides an overview of the management and surveillance of gastric metaplasia (GIM), a precursor lesion to gastric cancer. The author highlights the importance of GIM due to the high incidence and poor prognosis of gastric cancer in the United States compared to countries with structured screening programs. The development of gastric adenocarcinoma is driven by inflammation, predominantly due to H. pylori infection worldwide, while autoimmune gastritis is common in the United States. The prevalence of GIM in the US is estimated to be around 5%. Risk factors for GIM include race, ethnicity, sex, family history of gastric cancer, increasing age, H. pylori infection, and smoking. <br /><br />The diagnosis of GIM requires high-quality endoscopic exams, including mucosal cleaning, gas insufflation of the stomach, and adequate photodocumentation of the examined areas. The use of high-resolution endoscopes with narrow band imaging (NBI) is essential for detecting GIM. The histologic severity and topographic extent of GIM can be assessed using the Sydney protocol and the Operative Link scoring system. H. pylori eradication is recommended for all patients with GIM, as it reduces the risk of gastric cancer incidence and mortality. However, patients with GIM remain at an elevated risk even after H. pylori eradication. <br /><br />The document discusses risk stratification for GIM based on factors such as family history, extension, and histologic severity. Guidelines differ regarding the surveillance of GIM, with US guidelines recommending against routine surveillance and European guidelines advocating for surveillance based on the extent and histologic severity of GIM. Asian countries like South Korea and Japan have screening guidelines for gastric cancer, including regular endoscopic examinations for certain age groups. Ultimately, the decision for surveillance should involve shared decision-making between healthcare providers and patients, considering the risks and benefits. Education on the risks of gastric cancer and the benefits of surveillance is crucial for informed decision-making.

Keywords

gastric metaplasia

gastric cancer

H. pylori infection

endoscopic exams

high-resolution endoscopes

Sydney protocol

Operative Link scoring system

H. pylori eradication

risk stratification

surveillance guidelines