The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Diagnosis and management of gastric dysplasia

  • Sung, Jae Kyu (Department of Internal Medicine, Chungnam National University School of Medicine)
  • Received : 2016.02.01
  • Accepted : 2016.02.04
  • Published : 2016.03.01
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Abstract

Gastric dysplasia is a neoplastic lesion and a precursor of gastric cancer. The Padova, Vienna, and World Health Organization classifications were developed to overcome the discrepancies between Western and Japanese pathologic diagnoses and to provide a universally accepted classification of gastric epithelial neoplasia. At present, the natural history of gastric dysplasia is unclear. Much evidence suggests that patients with high-grade dysplasia are at high risk of progression to carcinoma or synchronous carcinoma. Therefore, endoscopic resection is required. Although patients with low-grade dysplasia have been reported to be at low risk of progression to carcinoma, due to the marked histologic discrepancies between forceps biopsy and endoscopic specimens, endoscopic resection for this lesion is recommended, particularly in the presence of other risk factors (large size; depressed gross type; surface erythema, unevenness, ulcer, or erosion; and tubulovillous or villous histology). Helicobacter pylori eradication in patients with dysplasia after endoscopic resection appear to reduce the incidence of metachronous lesions.

Keywords

References

  1. Correa P. A human model of gastric carcinogenesis. Cancer Res 1988;48:3554-3560.
  2. Morson BC, Sobin LH, Grundmann E, Johansen A, Nagayo T, Serck-Hanssen A. Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol 1980;33:711-721. https://doi.org/10.1136/jcp.33.8.711
  3. Ming SC. Dysplasia of gastric epithelium. Front Gastrointest Res 1979;4:164-172.
  4. Goldstein NS, Lewin KJ. Gastric epithelial dysplasia and adenoma: historical review and histological criteria for grading. Hum Pathol 1997;28:127-133. https://doi.org/10.1016/S0046-8177(97)90095-2
  5. Lewin KJ. Nomenclature problems of gastrointestinal epithelial neoplasia. Am J Surg Pathol 1998;22:1043-1047. https://doi.org/10.1097/00000478-199809000-00001
  6. Schlemper RJ, Kato Y, Stolte M. Review of histological classifications of gastrointestinal epithelial neoplasia: differences in diagnosis of early carcinomas between Japanese and Western pathologists. J Gastroenterol 2001;36:445-456. https://doi.org/10.1007/s005350170067
  7. Schlemper RJ, Itabashi M, Kato Y, et al. Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet 1997;349:1725-1729. https://doi.org/10.1016/S0140-6736(96)12249-2
  8. Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000;47:251-255. https://doi.org/10.1136/gut.47.2.251
  9. Schlemper RJ, Kato Y, Stolte M. Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol 2000;15 Suppl:G49-G57. https://doi.org/10.1046/j.1440-1746.2000.02266.x
  10. Yakirevich E, Resnick MB. Pathology of gastric cancer and its precursor lesions. Gastroenterol Clin North Am 2013;42:261-284. https://doi.org/10.1016/j.gtc.2013.01.004
  11. Lauwers GY, Riddell RH. Gastric epithelial dysplasia. Gut 1999;45:784-790. https://doi.org/10.1136/gut.45.5.784
  12. Setia N, Lauwers GY. Gastric dysplasia: update and practical approach. Diagn Histopathol 2015;21:312-322. https://doi.org/10.1016/j.mpdhp.2015.06.022
  13. Goddard AF, Badreldin R, Pritchard DM, Walker MM, Warren B; British Society of Gastroenterology. The management of gastric polyps. Gut 2010;59:1270-1276. https://doi.org/10.1136/gut.2009.182089
  14. Lansdown M, Quirke P, Dixon MF, Axon AT, Johnston D. High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut 1990;31:977-983. https://doi.org/10.1136/gut.31.9.977
  15. Di Gregorio C, Morandi P, Fante R, De Gaetani C. Gastric dysplasia: a follow-up study. Am J Gastroenterol 1993;88:1714-1719.
  16. Rugge M, Farinati F, Di Mario F, Baffa R, Valiante F, Cardin F. Gastric epithelial dysplasia: a prospective multicenter follow-up study from the Interdisciplinary Group on Gastric Epithelial Dysplasia. Hum Pathol 1991;22:1002-1008. https://doi.org/10.1016/0046-8177(91)90008-D
  17. Saraga EP, Gardiol D, Costa J. Gastric dysplasia: a histological follow-up study. Am J Surg Pathol 1987;11:788-796. https://doi.org/10.1097/00000478-198710000-00006
  18. Fertitta AM, Comin U, Terruzzi V, et al. Clinical significance of gastric dysplasia: a multicenter follow-up study: Gastrointestinal Endoscopic Pathology Study Group. Endoscopy 1993;25:265-268. https://doi.org/10.1055/s-2007-1010311
  19. Kokkola A, Haapiainen R, Laxen F, et al. Risk of gastric carcinoma in patients with mucosal dysplasia associated with atrophic gastritis: a follow up study. J Clin Pathol 1996;49:979-984. https://doi.org/10.1136/jcp.49.12.979
  20. Yamada H, Ikegami M, Shimoda T, Takagi N, Maruyama M. Long-term follow-up study of gastric adenoma/dysplasia. Endoscopy 2004;36:390-396. https://doi.org/10.1055/s-2004-814330
  21. de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 2008;134:945-952. https://doi.org/10.1053/j.gastro.2008.01.071
  22. Srivastava A, Lauwers GY. Gastric epithelial dysplasia: the Western perspective. Dig Liver Dis 2008;40:641-649. https://doi.org/10.1016/j.dld.2008.02.039
  23. Rugge M, Cassaro M, Di Mario F, et al. The long term outcome of gastric non-invasive neoplasia. Gut 2003;52:1111-1116. https://doi.org/10.1136/gut.52.8.1111
  24. Park SY, Jeon SW, Jung MK, et al. Long-term follow-up study of gastric intraepithelial neoplasias: progression from low-grade dysplasia to invasive carcinoma. Eur J Gastroenterol Hepatol 2008;20:966-970. https://doi.org/10.1097/MEG.0b013e3283013d58
  25. Carmack SW, Genta RM, Graham DY, Lauwers GY. Management of gastric polyps: a pathology-based guide for gastroenterologists. Nat Rev Gastroenterol Hepatol 2009;6:331-341. https://doi.org/10.1038/nrgastro.2009.70
  26. Abraham SC, Park SJ, Lee JH, Mugartegui L, Wu TT. Genetic alterations in gastric adenomas of intestinal and foveolar phenotypes. Mod Pathol 2003;16:786-795. https://doi.org/10.1097/01.MP.0000080349.37658.5E
  27. Zhao G, Xue M, Hu Y, Lai S, Chen S, Wang L. How commonly is the diagnosis of gastric low grade dysplasia upgraded following endoscopic resection? A meta-analysis. PLoS One 2015;10:e0132699. https://doi.org/10.1371/journal.pone.0132699
  28. Nam KW, Song KS, Lee HY, et al. Spectrum of final pathological diagnosis of gastric adenoma after endoscopic resection. World J Gastroenterol 2011;17:5177-5183. https://doi.org/10.3748/wjg.v17.i47.5177
  29. Jeon HK, Ryu HY, Cho MY, et al. A randomized trial to determine the diagnostic accuracy of conventional vs. jumbo forceps biopsy of gastric epithelial neoplasias before endoscopic submucosal dissection: open-label study. Gastric Cancer 2014;17:661-668. https://doi.org/10.1007/s10120-013-0322-2
  30. Tomasulo J. Gastric polyps. Histologic types and their relationship to gastric carcinoma. Cancer 1971;27:1346-1355. https://doi.org/10.1002/1097-0142(197106)27:6<1346::AID-CNCR2820270612>3.0.CO;2-V
  31. Cho SJ, Choi IJ, Kim CG, et al. Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy 2011;43:465-471. https://doi.org/10.1055/s-0030-1256236
  32. Choi CW, Kim HW, Shin DH, et al. The risk factors for discrepancy after endoscopic submucosal dissection of gastric category 3 lesion (low grade dysplasia). Dig Dis Sci 2014;59:421-427. https://doi.org/10.1007/s10620-013-2874-8
  33. Min BH, Kim KM, Kim ER, et al. Endoscopic and histopathological characteristics suggesting the presence of gastric mucosal high grade neoplasia foci in cases initially diagnosed as gastric mucosal low grade neoplasia by forceps biopsy in Korea. J Gastroenterol 2011;46:17-24.
  34. Kim MK, Jang JY, Kim JW, et al. Is lesion size an independent indication for endoscopic resection of biopsy-proven low-grade gastric dysplasia? Dig Dis Sci 2014;59:428-435. https://doi.org/10.1007/s10620-013-2805-8
  35. Lim H, Jung HY, Park YS, et al. Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia. Surg Endosc 2014;28:1256-1262. https://doi.org/10.1007/s00464-013-3316-6
  36. Won CS, Cho MY, Kim HS, et al. Upgrade of lesions initially diagnosed as low-grade gastric dysplasia upon forceps biopsy following endoscopic resection. Gut Liver 2011;5:187-193. https://doi.org/10.5009/gnl.2011.5.2.187
  37. Lee CK, Chung IK, Lee SH, et al. Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia? J Gastroenterol Hepatol 2010;25:1507-1513. https://doi.org/10.1111/j.1440-1746.2010.006367.x
  38. Park DI, Rhee PL, Kim JE, et al. Risk factors suggesting malignant transformation of gastric adenoma: univariate and multivariate analysis. Endoscopy 2001;33:501-506. https://doi.org/10.1055/s-2001-15089
  39. Kim JH, Kim YJ, An J, et al. Endoscopic features suggesting gastric cancer in biopsy-proven gastric adenoma with high-grade neoplasia. World J Gastroenterol 2014;20:12233-12240. https://doi.org/10.3748/wjg.v20.i34.12233
  40. Rugge M, Nitti D, Farinati F, di Mario F, Genta RM. Non-invasive neoplasia of the stomach. Eur J Gastroenterol Hepatol 2005;17:1191-1196. https://doi.org/10.1097/00042737-200511000-00007
  41. Weinstein WM, Goldstein NS. Gastric dysplasia and its management. Gastroenterology 1994;107:1543-1545. https://doi.org/10.1016/0016-5085(94)90561-4
  42. Nishida T, Tsutsui S, Kato M, et al. Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy. World J Gastrointest Pathophysiol 2011;2:93-99. https://doi.org/10.4291/wjgp.v2.i6.93
  43. Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002;51:130-131. https://doi.org/10.1136/gut.51.1.130
  44. ASGE Standards of Practice Committee, Evans JA, Chandrasekhara V, et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 2015;82:1-8. https://doi.org/10.1016/j.gie.2015.03.1967
  45. Dinis-Ribeiro M, Areia M, de Vries AC, et al. 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). Endoscopy 2012;44:74-94. https://doi.org/10.1055/s-0031-1291491
  46. Jang MY, Cho JW, Oh WG, et al. Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection. Korean J Intern Med 2013;28:687-693. https://doi.org/10.3904/kjim.2013.28.6.687
  47. Choi IJ. Current evidence of effects of Helicobacter pylori eradication on prevention of gastric cancer. Korean J Intern Med 2013;28:525-537. https://doi.org/10.3904/kjim.2013.28.5.525
  48. Uemura N, Mukai T, Okamoto S, et al. Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev 1997;6:639-642.
  49. Fukase K, Kato M, Kikuchi S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008;372:392-397. https://doi.org/10.1016/S0140-6736(08)61159-9
  50. Chey WD, Wong BC; Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol 2007;102:1808-1825. https://doi.org/10.1111/j.1572-0241.2007.01393.x
  51. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection: the Maastricht IV/ Florence Consensus Report. Gut 2012;61:646-664. https://doi.org/10.1136/gutjnl-2012-302084
  52. Asaka M, Kato M, Takahashi S, et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter 2010;15:1-20.
  53. Fock KM, Katelaris P, Sugano K, et al. Second Asia-Pacific Consensus Guidelines for Helicobacter pylori infection. J Gastroenterol Hepatol 2009;24:1587-1600. https://doi.org/10.1111/j.1440-1746.2009.05982.x
  54. Kim SG, Jung HK, Lee HL, et al. Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition. Korean J Gastroenterol 2013;62:3-26. https://doi.org/10.4166/kjg.2013.62.1.3
  55. Correa P, Fontham ET, Bravo JC, et al. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy. J Natl Cancer Inst 2000;92:1881-1888. https://doi.org/10.1093/jnci/92.23.1881
  56. Mera R, Fontham ET, Bravo LE, et al. Long term follow up of patients treated for Helicobacter pylori infection. Gut 2005;54:1536-1540. https://doi.org/10.1136/gut.2005.072009
  57. You WC, Brown LM, Zhang L, et al. Randomized double- blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions. J Natl Cancer Inst 2006;98:974-983. https://doi.org/10.1093/jnci/djj264
  58. Rugge M, Russo VM, Guido M. Review article: what have we learnt from gastric biopsy? Aliment Pharmacol Ther 2003;17 Suppl 2:68-74. https://doi.org/10.1046/j.1365-2036.17.s2.15.x
  59. Shin SH, Jung da H, Kim JH, et al. Helicobacter pylori eradication prevents metachronous gastric neoplasms after endoscopic resection of gastric dysplasia. PLoS One 2015;10:e0143257. https://doi.org/10.1371/journal.pone.0143257
  60. Bae SE, Jung HY, Kang J, et al. Effect of Helicobacter pylori eradication on metachronous recurrence after endoscopic resection of gastric neoplasm. Am J Gastroenterol 2014;109:60-67. https://doi.org/10.1038/ajg.2013.404
  61. Chon I, Choi C, Shin CM, Park YS, Kim N, Lee DH. Effect of Helicobacter pylori eradication on subsequent dysplasia development after endoscopic resection of gastric dysplasia. Korean J Gastroenterol 2013;61:307-312. https://doi.org/10.4166/kjg.2013.61.6.307

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