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Review
. 2019 Jul 21;25(27):3546-3562.
doi: 10.3748/wjg.v25.i27.3546.

Identifying High-Risk Individuals for Gastric Cancer Surveillance From Western and Eastern Perspectives: Lessons to Learn and Possibility to Develop an Integrated Approach for Daily Practice

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Free PMC article
Review

Identifying High-Risk Individuals for Gastric Cancer Surveillance From Western and Eastern Perspectives: Lessons to Learn and Possibility to Develop an Integrated Approach for Daily Practice

Duc Trong Quach et al. World J Gastroenterol. .
Free PMC article

Abstract

Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer (GC) development. There are several approaches to identifying these subjects, including noninvasive methods, esophagogastroduodenoscopy and histology. The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate- and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient's risk level. In addition, imaging enhanced endoscopy (IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However, resource limitations are an important barrier in many regions worldwide. Thus, for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resource-sensitive approach.

Keywords: Chronic atrophic gastritis; Cost-effective; Dysplasia; Gastric atrophy; Gastric cancer; Intestinal metaplasia; Precancerous gastric lesions; Screening; Surveillance.

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
The estimated age-standardized incidence rate for gastric cancer in 2018 (both sexes, all ages)[1].
Figure 2
Figure 2
Possibly cost-effective approaches for identifying asymptomatic individuals with a high risk of gastric cancer development. 1The age-standardized incidence rate is greater than 20 per 100000. 2Applying selective screening for subjects with high-risk pre-endoscopic features. 3Not yet shown to reduce gastric cancer mortality. 4The performance of serum PG I/II ratio should be locally validated. 5Cost-effectiveness should be considered based on the local age-standardized incidence and the cost of esophagogastroduodenoscopy. In multi-ethnic populations, ethnicity-based screening for high-risk ethnic groups should be considered. EGD: Esophagogastroduodenoscopy; UGS: Upper gastrointestinal series; sPGr: Serum PG I/II ratio.
Figure 3
Figure 3
The age-standardized incidence and mortality rates of gastric cancer[1]. ASR: Age-standardized rate[1].
Figure 4
Figure 4
Resource-sensitive approaches to identifying high-risk patients who undergo esophagogastroduodenoscopy for any reason. WLE: White-light endoscopy; EGA: Endoscopic gastric atrophy; GC: Gastric cancer; IEE: Image-enhanced endoscopy.

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