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

Video Transcription

Video Summary

In this video, Dr. Robert J. Huang from Stanford University presents an update on the management and surveillance of gastric intestinal metaplasia (GIM). GIM is a precursor lesion along Correa's cascade and is associated with an increased risk of gastric cancer, even after Helicobacter pylori eradication. The prevalence of GIM in the US population is estimated to be about 5%. Risk factors for GIM include race, ethnicity, family history of gastric cancer, increasing age, and previous H. pylori infection. When diagnosing and stratifying GIM, high-quality endoscopic exams should be performed, including the use of narrowband imaging (NBI) and the latest generation endoscopes. Sydney protocol biopsies should also be used to assess the extent and severity of GIM. Treatment of H. pylori infection is recommended for patients with GIM, and its eradication has been shown to induce histologic regression and reduce the risk of subsequent cancer. However, surveillance for GIM is controversial, and guidelines from different regions vary in their recommendations. Shared decision-making should be utilized to determine the need for surveillance based on patient-level and tissue-level factors. Dr. Huang suggests discussing the risks and benefits of surveillance with patients and considering their preferences. Overall, the key principle is to educate patients and allow them to make informed decisions regarding surveillance.

Asset Subtitle

Robert Huang, MD

Keywords

gastric intestinal metaplasia

Correa's cascade

gastric cancer

Helicobacter pylori eradication

endoscopic exams

Sydney protocol biopsies