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.

Keywords: Gastric cancer, Endoscopy, Endoscopic imaging, Endoscopic mucosal resection, Endoscopic submucosal dissection

Core Tip: There have been numerous recent advances in the endoscopic detection, characterization and treatment of precancerous gastric lesions and early gastric cancers. Accumulating evidence suggests that endoscopic submucosal dissection results in at least equivalent disease-related outcomes with a marked reduction in morbidity compared to gastrectomy. Supportive data are robust in regions with high gastric cancer prevalence, however a paucity of western data results in inconsistencies in clinical practice in these regions. This article serves to review existing evidence regarding endoscopic imaging and therapeutics in gastric cancer, as well as identify future areas for research and development.