Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale 5112, SA, Australia.
World J Gastroenterol. 2021 Aug 21;27(31):5126-5151. doi: 10.3748/wjg.v27.i31.5126.
Gastric cancer accounts for a significant proportion of worldwide cancer-related morbidity and mortality. The well documented precancerous cascade provides an opportunity for clinicians to detect and treat gastric cancers at an endoscopically curable stage. In high prevalence regions such as Japan and Korea, this has led to the implementation of population screening programs. However, guidelines remain ambiguous in lower prevalence regions. In recent years, there have been many advances in the endoscopic diagnosis and treatment of early gastric cancer and precancerous lesions. More advanced endoscopic imaging has led to improved detection and characterization of gastric lesions as well as superior accuracy for delineation of margins prior to resection. In addition, promising early data on artificial intelligence in gastroscopy suggests a future role for this technology in maximizing the yield of advanced endoscopic imaging. Data on endoscopic resection (ER) are particularly robust in Japan and Korea, with high rates of curative ER and markedly reduced procedural morbidity. However, there is a shortage of data in other regions to support the applicability of protocols from these high prevalence countries. Future advances in endoscopic therapeutics will likely lead to further expansion of the current indications for ER, as both technology and proceduralist expertise continue to grow.
胃癌在全球癌症相关发病率和死亡率中占很大比例。有充分文献记载的癌前级联为临床医生提供了一个机会，可以在可通过内镜治愈的阶段检测和治疗胃癌。在日本和韩国等高发地区，这导致了人群筛查计划的实施。然而，在低发地区，指南仍然存在模糊性。近年来，早期胃癌和癌前病变的内镜诊断和治疗取得了许多进展。更先进的内镜成像技术提高了胃病变的检测和特征描述能力，以及在切除前更准确地描绘边缘的能力。此外，内窥镜检查中人工智能的早期有希望的数据表明，这项技术在最大限度地提高先进内镜成像的产量方面可能具有未来作用。日本和韩国的内镜切除术（ER）数据尤其可靠，ER 的治愈率高，手术发病率明显降低。然而，其他地区缺乏数据来支持这些高发国家的方案的适用性。内镜治疗的未来进展可能会进一步扩大 ER 的现有适应证，因为技术和手术专家的专业知识不断发展。
