MAPS II: updated guidelines for preneoplastic gastric lesions

  • Pimentel-Nunes P & al.
  • Endoscopy
  • 6 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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  • 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.

Key points

  • 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.

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