British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma

• Type: Article in International Scientific Journal
• Date: 2019

Authors

Banks, M (Author) Other; Graham, D (Author) Other; Jansen, M (Author) Other; Gotoda, T (Author) Other; Coda, S (Author) Other; di Pietro, M (Author) Other; Uedo, N (Author) Other; Bhandari, P (Author) Other; Pritchard, DM (Author) Other; Kuipers, EJ (Author) Other; Rodriguez Justo, M (Author) Other; Novelli, MR (Author) Other; Ragunath, K (Author) Other; Shepherd, N (Author) Other; Mario Dinis Ribeiro (Author) FMUP

Journal

Title: Gut

Vol. 68

Pages: 1545-1575

ISSN: 0017-5749

Publisher: BMJ PUBLISHING GROUP

Indexing

ISI Web of Knowledge - 162 Citations

Scopus - 166 Citations

Other information

Authenticus ID: P-00Q-TKV

DOI: 10.1136/gutjnl-2018-318126

Abstract (EN): Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis. Risk factors include Helicobacter pylori infection, family history of gastric cancer-in particular, hereditary diffuse gastric cancer and pernicious anaemia. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. High-quality endoscopy with full mucosal visualisation is an important part of improving early detection. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met.

Language: English

Type (Professor's evaluation): Dissemination

No. of pages: 31