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Review
. 2021 Dec 13;13(24):6242.
doi: 10.3390/cancers13246242.

Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

Darina Kohoutova  1   2 , Matthew Banks  3 , Jan Bures  2
Affiliations
Review

Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

Darina Kohoutova et al. Cancers (Basel). .

Abstract

The mortality rates of gastric carcinoma remain high, despite the progress in research and development in disease mechanisms and treatment. Therefore, recognition of gastric precancerous lesions and early neoplasia is crucial. Two subtypes of sporadic gastric cancer have been recognized: cardia subtype and non-cardia (distal) subtype, the latter being more frequent and largely associated with infection of Helicobacter pylori, a class I carcinogen. Helicobacter pylori initiates the widely accepted Correa cascade, describing a stepwise progression through precursor lesions from chronic inflammation to gastric atrophy, gastric intestinal metaplasia and neoplasia. Our knowledge on He-licobacter pylori is still limited, and multiple questions in the context of its contribution to the pathogenesis of gastric neoplasia are yet to be answered. Awareness and recognition of gastric atrophy and intestinal metaplasia on high-definition white-light endoscopy, image-enhanced endoscopy and magnification endoscopy, in combination with histology from the biopsies taken accurately according to the protocol, are crucial to guiding the management. Standard indications for endoscopic resections (endoscopic mucosal resection and endoscopic submucosal dissection) of gastric dysplasia and intestinal type of gastric carcinoma have been recommended by multiple societies. Endoscopic evaluation and surveillance should be offered to individuals with an inherited predisposition to gastric carcinoma.

Keywords: Helicobacter pylori; chromoendoscopy; early gastric adenocarcinoma; endoscopic mucosal dissection; endoscopic mucosal resection; endoscopy; hereditary gastric adenocarcinoma; sporadic gastric adenocarcinoma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proposed Correa pathway of the pathogenesis of Helicobacter pylori-associated intestinal-type distal gastric adenocarcinoma. Adopted from Correa et al. [46]; Fox et al. [47]; Quante et al. [36].
Figure 2
Figure 2
Sydney biopsy system. Site 1 and 2: Antrum; Site 3: Incisura; Site 4: Middle body, lesser curve; Site 5: Middle body, greater curve. According to Kono et al. [145].
Figure 3
Figure 3
High-resolution white-light endoscopy (WLE): Atrophic gastritis involving the distal body and the antrum: loss of folds, prominence of vessels, pallor.
Figure 4
Figure 4
High-resolution WLE, retroflexion: Atrophic gastritis involving the proximal body and the fundus: loss of gastric folds, prominence of vessels, pallor and atrophic border.
Figure 5
Figure 5
High-resolution WLE: intestinal metaplasia involving the gastric body and the antrum; grey-white mildly elevated plaques surrounded by patchy pink areas. Groove-type pattern.
Figure 6
Figure 6
High-resolution WLE, retroflexion: intestinal metaplasia involving the proximal gastric body and the fundus. Grey-white mildly elevated plaques surrounded by pale areas. Groove-type pattern.
Figure 7
Figure 7
Chart of marginal turbid band and light blue crest, indicative of gastric intestinal metaplasia. According to An et al. [148].
Figure 8
Figure 8
High-definition WLE (Figure 8), NBI (Figure 9) and NBI with magnification (Figure 10). Autoimmune gastritis with atrophy. Neoplasia 0-IIb (Paris classification) in the gastric antrum. Spontaneous oozing bleeding is visible on Figure 8 and Figure 9. Histology from subsequent ESD: moderately differentiated intramucosal adenocarcinoma of intestinal type. Courtesy Professor Stanislav Rejchrt, MD, PhD.
Figure 9
Figure 9
High-definition NBI.
Figure 10
Figure 10
High-definition NBI with magnification.
Figure 11
Figure 11
High-definition WLE (Figure 11 and Figure 12), NBI (Figure 13). Intestinal metaplasia with neoplasia 0-IIa+IIc (Paris classification) in the upper gastric body, lesser curve. Histology from subsequent ESD: moderately differentiated adenocarcinoma of intestinal type with submucosal invasion (sm2; invasion 1.5 mm). Courtesy Rudolf Repak, MD.
Figure 12
Figure 12
High-definition WLE.
Figure 13
Figure 13
High-definition NBI.
Figure 14
Figure 14
Standard indications for endoscopic resection of gastric dysplasia and intestinal type of gastric cancer.
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