摘要
Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia(LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric highgrade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection(ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection(ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.
Gastric adenocarcinoma generally culminates via theinflammation-metaplasia-dysplasia-carcinoma sequenceprogression. The prevalence of gastric adenomasshows marked geographic variation. Recently, therate of diagnosis of low-grade dysplasia （LGD） hasincreased due to increased use of upper endoscopy.Many investigators have reported that gastric highgradedysplasia has high potential for malignancy andshould be removed; however, the treatment for gastricLGD remains controversial. Although the risk of LGDprogression to invasive carcinoma has been reported tobe inconsistent, progression has been observed duringfollow-up. Additionally, the rate of upgraded diagnosisin biopsy-proven LGD is high. Therefore, endoscopicresection （ER） may be useful in the treatment anddiagnosis of LGD, especially if lesions are found to haverisk factors for upgraded histology after ER, such aslarge size, surface erythema or depressed morphology.Fatal complications in endoscopic submucosal dissection（ESD） are extremely low and its therapeutic and diagnosticoutcomes are excellent. Therefore, ESD shouldbe applied preferentially instead of endoscopic mucosalresection.
