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World J Gastrointest Endosc. Apr 16, 2015; 7(4): 396-402
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.396
Optimal management of biopsy-proven low-grade gastric dysplasia
Jung-Wook Kim, Jae Young Jang
Jung-Wook Kim, Jae Young Jang, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul 130-702, South Korea
Author contributions: Kim JW wrote the paper; Jang JY designed and edited the paper.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jae Young Jang, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, 1 Hoegi-dong Dongdaemun-gu, Seoul 130-702, South Korea. jyjang@khu.ac.kr
Telephone: +82-2-9588200 Fax: +82-2-9681848
Received: November 3, 2014
Peer-review started: November 4, 2014
First decision: November 27, 2014
Revised: December 22, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 16, 2015
Abstract

Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia (LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric high-grade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection (ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection (ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.

Keywords: Intraepithelial neoplasia, Low-grade dysplasia, Adenoma, Endoscopic resection, Endoscopic submucosal dissection

Core tip: According to the guideline, endoscopic resection or follow-up is recommended for noninvasive category 3 low-grade dysplasias (LGDs), while category 4 lesions such as high-grade dysplasia, non-invasive carcinoma and intramucosal carcinoma should be removed by local resection. However, as LGD has a relatively high underdiagnosis rate and rarely contains submucosal cancer, a follow-up strategy might result in the opportunity for endoscopic therapy being missed. Furthermore, repeated endoscopic examinations with biopsies might impose a psychological and financial burden on the patient. Based on its efficacy and safety, the use of endoscopic submucosal dissection as a primary procedure for LGD should be considered.