Gastric cancer remains a major global public health challenge, highlighting the critical need for early detection and comprehensive risk assessment [2], [5]. Upper gastrointestinal endoscopy, or esophagogastroduodenoscopy (EGD), serves as the primary tool for diagnosing mucosal abnormalities, pre-neoplastic conditions, and early malignancies [2], [8]. While advanced endoscopic techniques have improved diagnostic accuracy, identifying high-risk individuals and recognizing subtle mucosal changes remain essential for improving patient outcomes [7], [8].
Precursor Lesions and Endoscopic Findings
Chronic atrophic gastritis (CAG) is widely recognized as the principal precursor lesion for gastric adenocarcinoma, making it a primary target for endoscopic surveillance [8]. During routine or specialized evaluations, gastroenterologists look for specific mucosal features that indicate high-risk states. These include the disappearance of the regular arrangement of collecting venules, intestinal metaplasia, atrophic changes, and signs of chronic inflammation [1], [8]. In patients who have undergone previous stomach surgery, such as distal gastrectomy, remnant gastric mucosal characteristics—including anastomotic redness, red streaks, and bile reflux—help stratify the risk of developing remnant gastric cancer into low, moderate, or high categories [1]. Furthermore, infections such as Helicobacter pylori are closely linked to erosive gastritis and ongoing mucosal damage, reinforcing the importance of identifying infectious drivers during gastroscopy [5].
Challenges in Early Detection and Anatomical Blind Spots
Despite technological advancements, early gastric lesions can occasionally be overlooked during routine endoscopic evaluations [2]. Anatomically challenging areas, such as the incisura angularis, are recognized as high-risk sites for gastric neoplasia and may function as potential blind spots during standard upper endoscopies [2]. Lesions missed during an initial procedure can lead to delayed diagnoses, emphasizing the necessity of meticulous, high-quality mucosal inspection [2]. Global disparities in incidence and stage at diagnosis further underscore the need to optimize endoscopic techniques and minimize procedural variability across clinical practices [7].
Post-Resection Surveillance and Metachronous Cancer
For patients who undergo endoscopic submucosal dissection (ESD) for early gastric cancer followed by successful eradication of Helicobacter pylori, the preservation of the remaining stomach means that new lesions can still develop [3]. This subsequent development of a new cancer at a distinct site is known as metachronous gastric cancer [3]. Structured surveillance protocols—typically involving follow-up endoscopies at specific post-resection intervals—are essential for identifying these new lesions early, when minimally invasive interventions remain viable [3], [8].
Innovations in Diagnostic Imaging
To combat the limitations of conventional white-light endoscopy, the medical field is increasingly turning toward advanced imaging modalities and artificial intelligence-assisted systems [8]. These modern innovations aim to enhance the visibility of subtle mucosal shifts, atrophic gastritis, and early gastric cancer stages [8]. By integrating high-resolution visualization tools with careful risk stratification based on patient history and endoscopic findings, clinicians can better target surveillance efforts and reduce overall gastric cancer mortality [1], [8].
Sources
- [1] Endoscopic Features of Background Gastritis Associated With Remnant Gastric Cancer: A Multicenter Retrospective Study. PubMed
- [2] Gastric Adenocarcinoma Missed at the Incisura Angularis During Initial Endoscopy: A Case Report. PubMed
- [3] A Nomogram for Predicting Metachronous Gastric Cancer After Endoscopic Submucosal Dissection of Early Gastric Cancer Following Successful Helicobacter pylori Eradication. PubMed
- [4] Factors Related to Abnormal Endoscopic and Histologic Findings on Upper Gastrointestinal Endoscopy in Children. PubMed
- [5] Prevalence, Risk Factors, and Endoscopic Findings of Helicobacter pylori Infection Among Lebanese Patients Undergoing Gastroscopy: A Retrospective Study from a Single Tertiary Center. PubMed
- [6] Association Between ER/PR-Positive Breast Tumors and Digestive Cancers. PubMed
- [7] Early Detection of Gastric Cancer: Linking Epidemiology, Pathophysiology, and Innovations in Digestive Endoscopy. PubMed
- [8] Endoscopic Diagnosis of Chronic Atrophic Gastritis and Early Gastric Cancer: From Basics to Advanced Imaging. PubMed