Recent advances in the detection and management of early gastric cancer and its precursors.
Recent advances in the detection and management of early gastric cancer and its precursors.
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DOI：
10.1136/flgastro-2018-101089
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发表时间：
2021
影响因子：
2.6
通讯作者：
Banks M
中科院分区：
文献类型：
--
作者：
Waddingham W;Nieuwenburg SAV;Carlson S;Rodriguez-Justo M;Spaander M;Kuipers EJ;Jansen M;Graham DG;Banks M
尽管发病率有所下降，但胃癌仍然是一种预后不良且治疗选择有限的疾病，因为其诊断往往已处于晚期。相比之下，早期胃癌预后良好至极好，内镜切除后5年生存率高达92.6%。这种疾病仍然存在东西方分歧，日本等高发病率国家的诊断较早并降低了死亡率，部分原因是国家筛查计划的成功。由于西方上消化道内镜检查漏诊癌症的情况仍然普遍存在，而且评估高危胃的方法也多种多样，因此我们提供的内窥镜检查质量必须成为改进的重点，特别要关注少数癌症风险较高的患者。虚拟色素内窥镜的高清内窥镜检查优于单独的白光内窥镜检查。这些增强的成像方式使经验丰富的内窥镜医师能够准确、稳健地检测胃中的高风险病变。内镜主导的分期策略意味着可以进行活检，以在组织学上确认癌前病变的内镜印象，包括萎缩性胃炎、胃肠化生、不典型增生和早期癌症。这种质量改进方法将减少漏诊，并与专家中心采用的最新内窥镜切除技术相结合，将改善早期发现并最终改善患者预后。在这篇综述中，我们概述了与早期胃癌及其癌前病变的诊断、分期和治疗相关的最新证据。
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. In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. 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. 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. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. 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. 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. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions.
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影响因子：
3.5
作者：
Dinis-Ribeiro, M.;Areia, M.;Kuipers, E. J.
通讯作者：
Kuipers, E. J.
影响因子：
3.1
作者：
Capelle, Lisette G.;Haringsma, Jelle;de Vries, Annemarie C.;Steyerberg, Ewout W.;Biermann, Katharina;van Dekken, Herman;Kuipers, Ernst J.
通讯作者：
Kuipers, Ernst J.
影响因子：
3.7
作者：
Huang YK;Yu JC;Kang WM;Ma ZQ;Ye X;Tian SB;Yan C
通讯作者：
Yan C
影响因子：
4.1
作者：
Gonzalez, Carlos A.;Miguel Sanz-Anquela, Jose;Gisbert, Javier P.
通讯作者：
Gisbert, Javier P.
影响因子：
7.7
作者：
Buxbaum, James L.;Hormozdi, David;Laine, Loren
通讯作者：
Laine, Loren