早期胃癌规范化内镜评估和治疗值得关注的问题

Standardized endoscopic evaluation and treatment of early gastric cancer

内镜治疗已成为低淋巴结转移风险的早期胃癌治疗的首选方式。近年来,关于内镜治疗的规范化流程也有了相应的指南与共识。在早期胃癌内镜规范化诊疗方面,建议从术前筛查开始即对病人进行危险等级评分和分级,然后进行系统性筛查,并记录癌前病变等发现。如发现可疑病灶,建议结合色素内镜和图像增强内镜帮助作出完整的术前诊断,根据病理学检查结果,严格把握内镜切除适应证。内镜切除应保证整块切除和切缘阴性,术后病理学评估也应完整、全面。根据术后病理学检查结果决定内镜治疗是否为治愈性切除,并作出相应的后续治疗或采取相应的随访监测手段。

Endoscopic resection is becoming the preferred primary treatment for early gastric cancer with a low incidence of lymph node metastasis.There have been published guidelines and consensus on the standardized endoscopic diagnosis and treatment in recent years.As part of the standardized endoscopic process,risk stratification regarding gastric cancer should be performed prior to gastroscopy.This is followed by a systematic gastroscopic mapping.The pre-malignant mucosal changes should be noted during screening.Chromoendoscopy and Image-Enhanced Endoscopy are recommended to assist the preoperative diagnosis for any suspicious lesion.Indication for endoscopic resection is according to the pathologic findings post biopsy.There are two main goals of a successful endoscopic resection:en bloc resection and negative margins.The final pathological diagnosis should be comprehensive and systematic.Follow-up surveillance or additional surgery should be based on the eCure system.