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Abstract：
Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis. Risk factors include Helicobacter pylori infection, family history of gastric cancer-in particular, hereditary diffuse gastric cancer and pernicious anaemia. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. High-quality endoscopy with full mucosal visualisation is an important part of improving early detection. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met.
摘要：
胃腺癌预后差，部分原因是诊断的后期。危险因素包括幽门螺杆菌感染，胃癌家族史-特别是，遗传性弥漫性胃癌和恶性贫血。癌症进展的阶段包括慢性胃炎，胃萎缩（GA），胃肠上皮化生（GIM）和异型增生。早期发现癌症和提高生存率的关键是在内窥镜检查前非侵入性地识别有风险的人。然而,尽管生物标志物可能有助于慢性萎缩性胃炎患者的检测，没有足够的证据支持它们用于人群筛查.具有完整粘膜可视化的高质量内窥镜检查是改善早期检测的重要组成部分。图像增强内窥镜检查结合组织病理学活检采样是检测并准确进行GA和GIM风险分层的最佳方法。根据悉尼协议从胃窦进行活检，incisura,更小和更大的曲率允许诊断确认和癌症进展的风险分层.理想情况下，活检应针对高质量内窥镜检查显示的GA或GIM区域。没有足够的证据支持在低风险人群（接受常规诊断食管胃十二指肠镜检查）中进行筛查，例如英国，但对于广泛的GA或GIM患者,应每3年进行一次内镜监测.内镜下黏膜切除术或内镜下黏膜下剥离术治疗可见胃异型增生和早期癌已被证明是有效的，成功率高，复发率低。前提是满足特定的质量标准。
