Novel treatment for gastric intestinal metaplasia, a precursor to cancer

Abstract

Background and Aim Gastric intestinal metaplasia (GIM) is precancerous with a worldwide prevalence of 25%. Eradicating H elicobacter pylori prevented about half of gastric cancers; failure to prevent the rest was attributed to GIM. GIM is irreversible and often extensive. There is no treatment. Existing endoscopic mucosal resection (EMR) is designed to treat early gastric cancer of usually <2 cm. We designed a two ‐endoscope technique of EMR for extensive lesions such as GIM. Methods Forty patients with histologically confirmed moderate to severe GIM (operative link on GIM [OLGIM] classification) received the treatment in a daycare center. Chromoendoscopy with methylene blue was first performed to indicate the GIM. Submucosal saline injections were used to lift the stained mucosa to form multiple safety cushions, which were transformed into artificial polyps by suction and ligation, using a cap familiar to gastroenterologists for ligation of esophageal varices. EMRs were then achieved by snare polypectomy. By rotating two gastroscopes, one was designated to perform lift and snare and the other to perform suction and ligation; cycles of lift–ligate–snare were performed until all stained mucosa was removed. Assessment chromoendoscopy with ≥seven biopsies was performed at 6 months. Results A total of 227 EMRs were performed, with a median of 3.5 per patient. Bleeding was uncommon and minimal. Gastric perforation ascribable to loss of a safety cushion occurred in one patient. Chromoendoscopy at 6 months in 36 willing patients showed no recurrence of GIM. Conclusion The two‐endoscope technique of EMR for GIM was essentially safe and effective, with no recurrence at 6 months. It could be performed by endoscopists with standard skills.

Molecular Alterations in Gastric Intestinal Metaplasia

“…Even though it is considered that intestinal metaplasia cannot be reversed [ 6 ], the possibility remains in the interest of scientists [ 18 , 19 ]. Gastric intestinal metaplasia has no specific treatment [ 20 ]. The progression of H. pylori -associated IM could be halted by the eradication of this bacterium.…”

“…Regular surveillance in high-risk patients and the prevention of IM is one of the main management methods recommended by the guidelines. Modern treatment methods, such as endoscopic mucosal resection, are currently being investigated to treat gastric IM and show promising results [ 20 ]. Gastric IM is usually diagnosed by performing upper endoscopy with biopsy, and there are several histologic classification systems to determine the risk of IM progression to GC [ 23 , 24 ].…”

Endoscopic methods for the detection and treatment of gastric cancer

“…The 2015 European Society of Gastrointestinal Endoscopy guidelines also include differentiated lesions < 3 cm with superficial submucosal invasion (SM1 ≤ 500 μm) [27]. Conventional endoscopic mucosal resection (EMR) can be used for resection of EGC lesions confined to the mucosa which are less than 2 cm in size [29]. The Korean Gastric Cancer Association published its own set of guidelines in 2019 [30].…”

Deep learning for diagnosis of precancerous lesions in upper gastrointestinal endoscopy: A review

“…GIM is the replacement of gastric-type mucinous epithelial cells with intestinal-type cells, which is a precancerous lesion with a worldwide prevalence of 25%[ 56 ]. The morphological characteristics of GIM are subtle and difficult to observe, so the manual diagnosis of GIM is full of challenges.…”