Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019

Abstract

Main RecommendationsPatients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent Helicobacter pylori gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up with a high quality endoscopy every 3 years. In patients with dysplasia, in the absence of an endoscopically defined lesion, immediate high quality endoscopic reassessment with CE is recommended. Patients with an endoscopically visible lesion harboring low or high grade dysplasia or carcinoma should undergo staging and treatment. H. pylori eradication heals nonatrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions, and it is recommended. H. pylori eradication is also recommended for patients with neoplasia after endoscopic therapy. In intermediate to high risk regions, identification and surveillance of patients with precancerous gastric conditions is cost-effective.

Natural history of autoimmune atrophic gastritis: a prospective, single centre, long‐term experience

“…The latest MAPS guidelines, in the absence of long‐term studies, recommend a generic endoscopic surveillance of 3‐5 years for AAG patients, regardless of disease stage . Our data seem to point at a more intensive surveillance for patients with stage 3 compared to 1 or 2, since patients with stage 3 AAG bear the highest risk of developing glandular or neuroendocrine dysplasia or neoplasia.…”

“…CrA, instead, seems to have little usefulness in this setting. The presence of additional risk factors, including family history of gastric cancer and common variable immunodeficiency, prompt endoscopic surveillance every 1‐2 years. In all cases, high‐definition endoscopy with chromoendoscopy should be offered, as it may increase the probability to detect small lesions.…”

“…However, no study has specifically and prospectively assessed the actual evolution of the disease from one stage to the other, nor the time span during which the evolution occurs. This is even more relevant, considering that the recent European MAPS guidelines generically suggest a 3‐ to 5‐year follow‐up, without further stratifying AAG patients who may need a more intensive endoscopic surveillance …”

Role of TFF3 as an adjunct in the diagnosis of Barrett's esophagus using a minimally invasive esophageal sampling device—The CytospongeTM

“…21 647 patients with known BE (cases) and 463 patients with dyspepsia and reflux symptoms (controls) were tested using the Cytosponge TM -TFF3 assay directly prior to an endoscopy. 36 In the aforementioned studies TFF3 immunohistochemistry was undertaken on two sections from the paraffin block. The sensitivity increased to 87% for longer, >3 cm circumferential segments of BE, and was 90% in patients who undertook the Cytosponge TM test on more than one occasional during the study.…”

Editorial: determinants of diagnostic delay in autoimmune atrophic gastritis—a salutary lesson

“…The authors suggest these symptoms and signs should prompt investigation to exclude AIG and present a useful schematic of high‐risk conditions as listed above. There is a lack of guidelines for diagnosis and management of this condition, although recent guidelines from Europe (MAPS II) state that once diagnosis is confirmed, these patients may benefit from endoscopic follow‐up every 3‐5 years for surveillance …”