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Abstract：
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.
摘要：
患有慢性萎缩性胃炎或肠上皮化生（IM）的患者有患胃腺癌的风险。这强调了对这些患者进行诊断和风险分层的重要性。为此，具有色素内窥镜检查（CE）的高清内窥镜检查比单独的高清白光内窥镜检查更好。虚拟CE可以指导活检以分期萎缩性和化生改变，并且可以靶向肿瘤病变。活检应从至少两个地形部位（胃窦和语料库）进行，并在两个单独的小瓶中进行标记。对于轻度至中度萎缩仅限于胃窦的患者，没有证据建议进行监测。在单一位置患有IM但有胃癌家族史的患者中，不完整的IM，或持续性幽门螺杆菌胃炎,可以在3年内考虑采用CE和引导活检的内镜监测.萎缩性胃炎晚期患者应每3年进行一次高质量的内镜检查。在发育不良的患者中，在没有内窥镜定义的病变的情况下，建议立即使用CE进行高质量的内窥镜重新评估。具有内窥镜可见病变的低度或高度异型增生或癌的患者应进行分期和治疗。根除幽门螺杆菌治疗非萎缩性慢性胃炎，可能导致萎缩性胃炎的消退，并降低患有这些疾病的患者患胃癌的风险，它是推荐的。对于内镜治疗后的肿瘤患者，也建议根除幽门螺杆菌。在中高风险地区，识别和监测胃癌前病变患者是符合成本效益的.
