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The evolving role of endoscopy in the diagnosis of premalignant gastric lesions [version 1; referees: 4 approved]

Authors :
William Waddingham
David Graham
Matthew Banks
Marnix Jansen
Source :
F1000Research, Vol 7 (2018)
Publication Year :
2018
Publisher :
F1000 Research Ltd, 2018.

Abstract

Gastric adenocarcinoma is a disease that is often detected late, at a stage when curative treatment is unachievable. This must be addressed through changes in our approach to the identification of patients at increased risk by improving the detection and risk assessment of premalignant changes in the stomach, including chronic atrophic gastritis and intestinal metaplasia. Current guidelines recommend utilising random biopsies in a pathology-led approach in order to stage the extent and severity of gastritis and intestinal metaplasia. This random method is poorly reproducible and prone to sampling error and fails to acknowledge recent advances in our understanding of the progression to gastric cancer as a non-linear, branching evolutionary model. Data suggest that recent advances in endoscopic imaging modalities, such as narrow band imaging, can achieve a high degree of accuracy in the stomach for the diagnosis of these premalignant changes. In this review, we outline recent data to support a paradigm shift towards an endoscopy-led approach to diagnosis and staging of premalignant changes in the stomach. High-quality endoscopic interrogation of the chronically inflamed stomach mucosa, supported by targeted biopsies, will lead to more accurate risk assessment, with reduced rates of under or missed diagnoses.

Details

Language :
English
ISSN :
20461402
Volume :
7
Database :
Directory of Open Access Journals
Journal :
F1000Research
Publication Type :
Academic Journal
Accession number :
edsdoj.2c3c8b4d5db14421b0d8ce0585ff4dd6
Document Type :
article
Full Text :
https://doi.org/10.12688/f1000research.12087.1