- 4 European societies released updated guidelines (MAPS II) for managing patients with precancerous conditions and lesions.
Why this matters
- Gastric cancer is often fatal when diagnosed, making early detection and management crucial.
- High-definition endoscopy with chromoendoscopy (CE) is better than high-definition white-light endoscopy for gastric adenocarcinoma diagnosis and risk stratification of patients with chronic atrophic gastritis or intestinal metaplasia (IM).
- Virtual CE can target neoplastic lesions and guide biopsies for staging atrophic and metaplastic changes. Two sites (antrum and corpus) should be biopsied and labeled in separate vials.
- No evidence supports surveillance of mild to moderate atrophy restricted to the antrum.
- For single-location IM with a family history of gastric cancer, incomplete IM, or persistent Helicobacter pylori gastritis, clinicians may use CE surveillance and guided biopsies at 3 years.
- Surveil advanced atrophic gastritis using high-quality endoscopy every 3 years.
- Immediately reassess dysplasia without an endoscopically defined lesion, using high-quality CE.
- Stage and treat patients with an endoscopically visible lesion with low- or high-grade dysplasia or carcinoma.
- Eradicate H pylori in nonatrophic chronic gastritis and neoplasia after endoscopic therapy.
- Identification and surveillance is cost-effective for patients with precancerous gastric conditions in intermediate to high-risk regions.