![]() Where endoscopic appearances suggest CAG and/or GIM, staging biopsies should be taken from at least two areas of the stomach (antrum and corpus, lesser and greater curve for each). High-definition endoscopy with image enhancement (eg, Olympus NBI, Pentax iScan, Fujinon intelligent chromo endoscopy (FICE)) is preferred over high-definition white light endoscopy alone for the recognition of gastric premalignant conditions. Up to 10% of gastric cancers are missed at upper endoscopy, focus should be on quality improvement in upper gastrointestinal endoscopy.Ĭhronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) are both precursors to gastric cancer and warrant ongoing cancer surveillance if changes are extensive. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions. This approach to quality improvement will reduce missed diagnoses and, combined with the latest endoscopic resection techniques performed at expert centres, will improve early detection and ultimately patient outcomes. An endoscopy-led staging strategy would mean biopsies could be targeted to histologically confirm the endoscopic impression of premalignant lesions including atrophic gastritis, gastric intestinal metaplasia, dysplasia and early cancer. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. With missed cancers still prevalent at upper endoscopy in the West, and variable approaches to assessment of the high-risk stomach, the quality of endoscopy we provide must be a focus for improvement, with particular attention paid to the minority of patients at increased cancer risk. There remains an East-West divide for this disease, with high incidence countries such as Japan seeing earlier diagnoses and reduced mortality, in part thanks to the success of a national screening programme. ![]() In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. Despite declines in incidence, gastric cancer remains a disease with a poor prognosis and limited treatment options due to its often late stage of diagnosis. ![]()
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