Endoscopic Management of Gastric Neoplasia
Summary
Endoscopic management has transformed the approach to gastric neoplasia by enabling accurate diagnosis, staging and minimally invasive treatment of precancerous and early malignant lesions. High-definition white-light endoscopy supplemented by image-enhancement techniques—such as narrow-band imaging and chromoendoscopy—allows endoscopists to delineate subtle mucosal abnormalities, identify vascular and pit-pattern irregularities and target biopsies with greater precision. Endoscopic ultrasound provides complementary assessment of lesion depth and involvement of the submucosa, informing the choice between endoscopic resection and surgical referral. Therapeutic techniques have evolved from endoscopic mucosal resection, suitable for small and non-ulcerated lesions, to endoscopic submucosal dissection, which achieves en bloc excision of larger or fibrotic lesions with clear lateral and vertical margins. Emerging advances include traction-assisted dissections, hybrid knife technology and computer-aided detection systems designed to enhance lesion localisation and reduce procedure time. Patient selection and risk stratification rely on lesion characteristics—size, location, ulceration status and histological grade—as well as patient comorbidities and surgical fitness. Long-term outcome data confirm high rates of complete resection, low recurrence and favourable survival, establishing endoscopic management as the standard of care for early gastric neoplasia in high-incidence regions and increasingly in Western centres.
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Endoscopic Management of Gastric Neoplasia publication trend
The graph below shows the total number of articles in endoscopic management of gastric neoplasia across all publications each year (not limited to Nature Index journals).
Technical terms
Endoscopic mucosal resection: Removal of superficial neoplastic lesions confined to the mucosa using snare-based techniques.
Endoscopic submucosal dissection: A method for en bloc excision of larger or fibrotic lesions by dissecting the submucosal plane with specialised knives.
Low-grade dysplasia: A precancerous epithelial lesion characterised by mild cytological atypia without architectural distortion.
High-grade dysplasia: A precancerous lesion with marked cytological atypia and complexity of glandular architecture, carrying a high risk of progression.
Chromoendoscopy: Application of topical dyes during endoscopy to enhance mucosal contrast and lesion detection.
Narrow-band imaging: An optical filter technology that highlights superficial mucosal and vascular patterns for improved lesion characterisation.
References
- Chinese integrated guideline on the management of gastric precancerous conditions and lesions. Chinese Medicine (2022).
- How Commonly Is the Diagnosis of Gastric Low Grade Dysplasia Upgraded following Endoscopic Resection? A Meta-Analysis. PLOS ONE (2015).
- Establishment and validation of a model to determine the progression risk of low grade intraepithelial neoplasia. Surgical Endoscopy (2020).
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