Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

Abstract

Gastric cancer accounts for a significant proportion of worldwide cancer-related morbidity and mortality. The well documented precancerous cascade provides an opportunity for clinicians to detect and treat gastric cancers at an endoscopically curable stage. In high prevalence regions such as Japan and Korea, this has led to the implementation of population screening programs. However, guidelines remain ambiguous in lower prevalence regions. In recent years, there have been many advances in the endoscopic diagnosis and treatment of early gastric cancer and precancerous lesions. More advanced endoscopic imaging has led to improved detection and characterization of gastric lesions as well as superior accuracy for delineation of margins prior to resection. In addition, promising early data on artificial intelligence in gastroscopy suggests a future role for this technology in maximizing the yield of advanced endoscopic imaging. Data on endoscopic resection (ER) are particularly robust in Japan and Korea, with high rates of curative ER and markedly reduced procedural morbidity. However, there is a shortage of data in other regions to support the applicability of protocols from these high prevalence countries. Future advances in endoscopic therapeutics will likely lead to further expansion of the current indications for ER, as both technology and proceduralist expertise continue to grow.

Gastric Cancer Screening Methods: A Comparative Study of the Chinese New Gastric Cancer Screening Score and Kyoto Classification of Gastritis

“…Gastric cancer is one of the common malignant tumors. The early detection, diagnosis, and treatment of gastric cancer play an important role in improving the survival rate of gastric cancer and reducing medical expenditure [ 19 ]. At present, China still faces the situation of large population and uneven distribution of medical resources, so the feasibility of recommending all patients to carry out gastroscope screening for gastric cancer is relatively poor.…”

“…The new gastric cancer screening scoring system has been established in the expert consensus opinion of the early gastric cancer screening project in China [ 16 , 19 ]. The Chinese new gastric cancer screening scoring system include 5 variables with a total score of 23: (1) age: 0 for 40-49, 5 for 50-59, 6 for 60-69, and 10 for >69; (2) sex: 4 for male and 0 for female; (3) H. pylori infection (Hp antibody test): positive 1 and negative 0; (4) PGR (serum pepsinogen I/II ratio): ≥3.89 is 0 and <3.89 is 3; and (5) G-17 (gastrin 17): less than 1.50 is 0, 1.50-5.70 is 3, and greater than 5.70 is 5 ( Table 1 ).…”

Endoscopic Classifications of Early Gastric Cancer: A Literature Review

“…With the continuous development of endoscopic technologies, artificial intelligence (AI) in the field of endoscopy has become a new area of interest. One study by Hirasawa et al, which utilized convolutional neural networks to detect EGC in endoscopic images, showed that the sensitivity of AI for white light endoscopy and magnifying NBI were 92% and 97%, respectively [ 35 ]. Meanwhile, a study done by Niikura et al did not show inferiority nor superiority of AI when compared to expert endoscopists [ 36 ].…”

The Feasibility of Applying Artificial Intelligence to Gastrointestinal Endoscopy to Improve the Detection Rate of Early Gastric Cancer Screening

“…Gastric cancer is also the second leading cause of cancer deaths in China, with a standardized 5-year survival rate of only 27.4% ( 3 ). According to related research, there were approximately 1 million newly diagnosed gastric cancer cases in 2008, 47% of which were in China, which accounted for half of the global gastric cancer deaths ( 4 , 5 ). Of note, however: the 5-year survival rate of early gastric cancer (EGC) was over 90%, which was much higher than that of advanced gastric cancer (AGC) (30%) ( 6 – 8 ).…”