Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
J Korean Med Sci. 2019 Sep 9;34(35):e231. doi: 10.3346/jkms.2019.34.e231.
Detection of early-stage gastric cancer improves the prognosis of patients. Endoscopic submucosal dissection (ESD) is a curative and stomach-preserving treatment for early gastric cancer (EGC) associated with a low risk of lymph node metastasis. However, several studies have reported missed diagnosis of gastric cancer. Therefore, endoscopists are required to learn accurate diagnostic skills to eliminate endoscopic blind spots. A systematic screening protocol to map the entire stomach without blind spots reduces the risk of missed lesions. Knowledge of the features of EGC or dysplasia is essential to identify suspicious lesion. Information of the common sites of occurrence of EGC can also enable a detailed endoscopic examination to improve detection rates. Previous reports investigating the location of gastric cancers resected by ESD or surgery showed that the antrum and lesser curvature of stomach were predominantly affected. -induced atrophic changes advance from the antrum to the corpus along the lesser curvature, predominantly affecting these areas. Gastric cancers in the antrum and the lower corpus are also commonly missed during screening examination. Therefore, a careful examination of the lower third stomach is warranted to avoid missing synchronous and metachronous gastric lesions. Knowledge of the location of EGC enables accurate endoscopic examination and detection of EGC in early stage.
早期胃癌的检测可改善患者的预后。内镜黏膜下剥离术（ESD）是一种治疗早期胃癌（EGC）的有治愈性且保留胃的方法，其淋巴结转移的风险较低。然而，有几项研究报告称存在胃癌漏诊的情况。因此，内镜医生需要学习准确的诊断技能以消除内镜的盲区。制定系统的筛查方案，对整个胃进行无盲区扫描，可降低漏诊的风险。了解 EGC 或异型增生的特征对于识别可疑病变至关重要。了解 EGC 常见发生部位的信息，也可使内镜检查更详细，从而提高检出率。之前有关 ESD 或手术切除的胃癌部位的研究报告表明，胃窦和小弯是主要受累部位。壁细胞损伤导致的萎缩性改变沿着小弯从胃窦向胃体进展，主要影响这些区域。在筛查检查中，胃窦和胃下部的胃癌也常被漏诊。因此，需要仔细检查胃的下三分之一，以避免漏诊同时性和异时性的胃部病变。了解 EGC 的位置有助于进行准确的内镜检查和早期 EGC 的检测。
