Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh 70000, Vietnam.
Health Service Center, Hiroshima University, Higashihiroshima 739-8514, Japan.
World J Gastroenterol. 2019 Jul 21;25(27):3546-3562. doi: 10.3748/wjg.v25.i27.3546.
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 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.
目前的证据表明，胃黏膜异型增生、重度及广泛胃萎缩、广泛肠化生和不完全型肠化生的个体发生胃癌（GC）的风险较高。有几种方法可以识别这些对象，包括非侵入性方法、食管胃十二指肠镜检查和组织学检查。西方国家的主要方法是基于组织学的，而 GC 高发的东亚国家则是基于内镜的。对于无症状个体，选择适用方法的关键问题是降低 GC 死亡率的能力和方法的成本效益。目前，基于人群的筛查计划仅在少数 GC 高危亚洲国家实施。基于人口统计学和临床特征（如种族、年龄、性别、吸烟和状况）的内镜前风险评估有助于识别具有高术前可能性的对象，对于中低风险国家，这可能是一种具有成本效益的方法。对于有食管胃十二指肠镜检查适应证的有症状患者，应强调机会性筛查的重要性。应始终考虑将内镜和组织学方法相结合，因为内镜可以实时评估患者的风险水平。此外，成像增强内镜（IEE）已被证明有助于进行靶向活检，从而使内镜和组织学发现之间具有更好的相关性。目前，建议在进行内镜检查时使用 IEE，并且只要可行，就应建议使用胃黏膜肠上皮化生操作链接或胃炎评估操作链接分级系统进行组织学检查。然而，资源限制是全球许多地区的一个重要障碍。因此，为了使方法在实际实践中适用，它不仅应该基于证据，还应该考虑资源敏感性。在这篇综述中，我们从西方和东方的角度讨论了当前对识别高危个体的理解和方法，以及一种综合的、资源敏感的方法的可能性。
