Endoscopy 2019; 51(04): 365-388
DOI: 10.1055/a-0859-1883
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019

Pedro Pimentel-Nunes
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
3   Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal,
,
Diogo Libânio
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
,
Ricardo Marcos-Pinto
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
4   Department of Gastroenterology, Porto University Hospital Centre, Institute of Biomedical Sciences, University of Porto (ICBAS/UP), Portugal
,
Miguel Areia
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
5   Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Portugal
,
Marcis Leja
6   Institute of Clinical and Preventive Medicine, University of Latvia, Digestive Diseases Center, GASTRO, Riga, Latvia
,
Gianluca Esposito
7   Department of Medicine, Surgery and Translational Medicine University Hospital Sant’Andrea, University Sapienza Roma, Rome, Italy
,
Monica Garrido
4   Department of Gastroenterology, Porto University Hospital Centre, Institute of Biomedical Sciences, University of Porto (ICBAS/UP), Portugal
,
Ilze Kikuste
6   Institute of Clinical and Preventive Medicine, University of Latvia, Digestive Diseases Center, GASTRO, Riga, Latvia
,
Francis Megraud
8   INSERM U1053, Université de Bordeaux and CHU Pellegrin, Laboratoire de Bacteriologie, Bordeaux, France
,
Tamara Matysiak-Budnik
9   IMAD, Hepato-Gastroenterology and Digestive Oncology, CHU de Nantes, University of Nantes, France
,
Bruno Annibale
7   Department of Medicine, Surgery and Translational Medicine University Hospital Sant’Andrea, University Sapienza Roma, Rome, Italy
,
Jean-Marc Dumonceau
10   Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Rita Barros
11   Institute of Molecular Pathology and Immunology at the University of Porto (Ipatimup), Porto, Portugal
12   Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
,
Jean-François Fléjou
13   Service d’Anatomie Pathologique, Hôpital Saint-Antoine, AP-HP, Faculté de Médecine Sorbonne Université, Paris, France
,
Fátima Carneiro
11   Institute of Molecular Pathology and Immunology at the University of Porto (Ipatimup), Porto, Portugal
12   Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
14   Pathology Department, Centro Hospitalar de São João and Faculty of Medicine, Porto, Portugal
,
Jeanin E. van Hooft
15   Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, The Netherlands
,
Ernst J. Kuipers
16   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Mario Dinis-Ribeiro
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
06 March 2019 (online)

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Main Recommendations

Patients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent Helicobacter pylori gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up with a high quality endoscopy every 3 years. In patients with dysplasia, in the absence of an endoscopically defined lesion, immediate high quality endoscopic reassessment with CE is recommended. Patients with an endoscopically visible lesion harboring low or high grade dysplasia or carcinoma should undergo staging and treatment. H. pylori eradication heals nonatrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions, and it is recommended. H. pylori eradication is also recommended for patients with neoplasia after endoscopic therapy. In intermediate to high risk regions, identification and surveillance of patients with precancerous gastric conditions is cost-effective.

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