Modern endoscopic techniques of precancerous stomach conditions diagnostics: problems and possibilities
The review shows the classification of precancerous stomach pathology, proposed in the Consensus Management of precancerous conditions and lesions in the stomach (MAPS) (2012), according to which they are divided into precancerous lesions (atrophic gastritis and intestinal metaplasia) and precancerous changes (stomach mucosa dysplasia). Chronic atrophic gastritis and intestinal metaplasia are considered precancerous conditions, as they are the background for development of dysplasia and gastric adenocarcinoma of intestinal type. Precancerous changes is gastric dysplasia and is the penultimate stage of gastric carcinogenesis sequence and is defined as histologically clear tumor epithelium without signs of infection, and thus is a direct tumor precancerous lesions. It is noted that, in general, the risk of stomach cancer is too small to justify by endoscopic observation in all the patients with atrophic gastritis and intestinal metaplasia. Thus, it is necessary to define additional risk factors for stomach cancer progression in that it is presented in the Kyoto global consensus on Helicobacter pylori-associated gastritis (2015) for this category of patients. It was determined that stomach cancer risk factors are the intragastric distribution and the extent of intestinal metaplasia, presence of a family history of gastric cancer, the definition of subtypes of intestinal metaplasia. Sydney system is used for chronic gastritis classification (Houston review), as well as classification by metaplasia type (non-metaplastic, metaplastic atrophy of uncertain type). There are three methods to determine the prevalence and extent of atrophic gastritis and intestinal metaplasia used: endoscopic, histological and serological. The atrophy severity of the gastric mucosa is determined histologically. Classification of atrophy severity by endoscopic parameters does not currently exist. Intestinal metaplasia developed in different parts of the stomach and is multifocal (in the antrum, along the small curvature of the stomach diffusely). According to the researchers’ data, the presence of the intestinal metaplasia on the lesser curvature of the stomach has a strong association with cancer risk. The different kinds of endoscopic devices allow diagnostically diffentiate atrophy and intestinal metaplasia of the stomach. Endoscopy white light can’t reliably diagnose stomach precancerous changes, while videoendoscopy with magnifications and narrow band imaging (NBI), according to researchers’ data, significantly improves the diagnosis of this disease. The basis of diagnosis is increasing verification of two main structures: the architectonic subepithelial microvascular network microstructure and mucosal surface, which has a different pattern in the body and antral stomach. But to date there is no common classification of changes to these structures in various pathological changes. There are a large number of classifications of changes in endoscopy with NBI mode and optical zoom: Yagi (2002), M. Dinis-Ribeiro (2003), G.K. Anagnostopoulos et al. (2007), T. Tahara (2009), P. Pimentel-Nunes, M. Dinis-Ribeiro (2012). It is noted that the problem is that NBI with zoom is practically impossible to use in daily clinical practice, the method requires a certain level of knowledge and endoscope type, available only in several centers, as well as the use of sedation for maximum effective inspection.
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Zaharash MP, Yakovenko BA, Kurik OG. NBI and high magnifying endoscopy: modern opportunities of endoscopic diagnostics. Ukrainian Journal of Minimally Invasive and Endoscopic Surgery. 2009;4:12-15. (In Ukrainian).
Zaharash MP, Pariy VD, Yakovenko BA. Skrining peredrakovih zmin i raku shlunka: Меtod. rekomendatcii [Skrining of precancerous changes and stomach cancer. Guidelines]. Кyiv; 2009. 33 p. (In Ukrainian).
Коtelevetc SМ. Morphological and functional comparison of the development of intestinal metaplasia of the gastric mucosa. Rossijskij zhurnal gastrojenterologii, gepatologii, koloproktol. 2007;17(22):80-83.in Russian).
Nikishaev VI, Bolotskih NA, Tumak IN. Management of patients with precancerous conditions and lesions in the stomach. Ukrai'ns'kyj zhurnal maloinvazyvnoi' ta endoskopichnoi' hirurgii'. 2013;1(17):25-50. (in Russian).
Dinis-Ribeiro M, Areia M, de Vries AC. Management of precancerous conditions and lesions in the stomach (MAPS). Guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Guideline. Endoscopy. 2012;44(1):74-94. doi: 10.1055%2Fs-0031-1291491.
Olmez S, Aslan M, Erten R, et al. The prevalence of gastric intestinal metaplasia and distribution of Helicobacter pylori infection, atrophy, dysplasia, and cancer in its subtypes. Gastroenterology research and practice. 2015. Article ID 434039. doi: 10.1155/2015/434039.
Walker MM. Intestinal Metaplasia and Dysplasia in the Stomach — Diagnostic Difficulties and Clinical Consequences. Available from: www.bdiap.org/Git/4Walker.htm.
Hun H, Uedo N. What have we accomplished in endoscopic image analysis for atrophic gastritis. The Korean Journal of Helicobacter and Upper Gastrointestinal research. 2013;13(1):6-19. doi: 10.7704/kjhugr.2013.13.1.6.
Takao T, Ishikawa T, Ando T, et al. Multifaceted assessment of chronic gastritis: a study of correlations between serological, endoscopic, and histological diagnostics. Gastroenterology Research and Practice. 2011;2011:631-637. doi: 10.1155%2F2011%2F631461.
Yakovenko VO, Zaharash MP, Kurik OG. Endoskopichna i morfologichna diagnostika, maloinvazivne likuvannya peredrakovih zmin slizovoyi obolonki shlunka [Endoscopic and morphologic diagnostics, miniinvasive treatment of precancerous changes of gastric mucosa]. Vinnitca: FOP Kashtelianov O.I.; 2013. 136 p. (іn Ukrainian).
Takemoto T. Endoscopic diagnosis of chronic gastritis. Diagnosis Ann. Treatment. 1966;54:1274-1285.
Toyoshima O, Yamaji Y, Matsumoto S, et al. Endoscopic gastric atrophy is strongly associated with gastric cancer development after Helicobacter pylori eradication. Surgical endoscopy. 2016. doi: 10.1007/s00464-016-5211-4.
Aruin LI, Kapuller LL, Isakov VA. Morfologicheskaya diagnostika bolezney zcheludka I kishechnika [Morphological diagnostics of stomach and colon diseases]. Мoscow: Triada-Х; 1998. 496 p.
East JE, Vleugels JL, Roelandt P, et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy. 2016;48(11):1029-1045. doi: 10.1055/s-0042-118087.
Tanaka K, Toyoda H, Kadowaki S, et al. Surface pattern classification by enhanced magnification endoscopy for identifying early gastric cancers. Gastrointest Endosc. 2008;67(3):430-7. doi: 10.1016/j.gie.2007.10.042.
Cohen J. Advanced digestive endoscopy. Comprehensive Atlas of High Resolution Endoscopy and Narrowband Imagine. Blackwell Publishing; 2012. 360 p.
Anagnostopoulos GK, Yao K, Kaye P, et al. High-resolution magnification endoscopy can reliably identify normal gastric mucosa, Helicobacter pylori-associated gastritis, and gastric atrophy. Endoscopy. 2007;39:1-6. doi: 10.1055/s-2006-945056.
Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB, et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy. 2012;44:236-246. doi: 10.1055/s-0031-1291537. Epub 2012 Jan 31.
Yao K, Iwashita A, Matsui T. A New Diagnostic vs Classification System Produced by Magnification Endoscopy Plus Narrow-Band Imaging in the Stomach: Microvascular Architecture and Microsurface Structure. In: Niwa, Hirohumi Tajiri, Hisao, Nakajima, Masatsugu, Yasuda, Kenji, editors. New Challenges in Gastrointestinal Endoscopy. 2008. 169-176p.
Singh R, Lee SY, Vijay N, Sharma P, Uedo N. Update on narrow band imaging in disorders of the upper gastrointestinal tract. Digestive Endoscopy.2014;26(2):144-153. doi: 10.1111/den.12207. Epub 2013 Dec 4.
Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. Journal of Gastroenterology and Hepatology. 2002;17(1):39-45.
Tahara T, Shibata T, Nakamura M, et al. Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinqushes histological and serological severity of chronic gastritis. Gastrointest Endoscopy. 2009;70:246-253. doi: 10.1016/j.gie.2008.11.046. Epub 2009 Apr 21.
Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastroentest Endoscopy. 2003;57(4);498-504. doi: 10.1067/mge.2003.145.
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