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
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
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DOI：
10.1055/a-0859-1883
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发表时间：
2019-04-01
期刊：
影响因子：
9.3
通讯作者：
Dinis-Ribeiro, Mario
中科院分区：
文献类型：
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作者：
Pimentel-Nunes, Pedro;Libanio, Diogo;Dinis-Ribeiro, Mario
慢性萎缩性胃炎或肠上皮化生（IM）患者有胃腺癌的风险。这强调了对这些患者进行诊断和风险分层的重要性。在此方面，高清晰度内窥镜联合色素内窥镜（CE）优于单独的高清晰度白光内窥镜。虚拟CE可以指导活检，对萎缩性和化生性病变进行分期，并可以靶向肿瘤性病变。活检应至少从两个局部部位（胃窦和胃体）进行，并在两个单独的小瓶中贴上标签。对于局限于胃窦的轻度至中度萎缩患者，没有证据建议进行监测。在单一部位IM但有胃癌家族史、不完全IM或持续性幽门螺杆菌胃炎的患者中，可考虑在3年内进行CE内镜监测和引导活检。晚期萎缩性胃炎患者应每3年随访一次高质量的内镜检查。对于不典型增生患者，如果没有内镜下明确的病变，建议立即用CE进行高质量的内镜下再评估。内窥镜下可见病变的患者应进行分期和治疗。H.幽门螺杆菌根除治疗非萎缩性慢性胃炎，可能导致萎缩性胃炎的消退，并降低患有这些疾病的患者患胃癌的风险，因此推荐使用。H.对于内镜治疗后的肿瘤患者，也推荐根除幽门。在中高危地区，对胃癌前病变患者的识别和监测具有成本效益。
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.