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Bright future for endoscopy: the new frontier of gastric cancer secondary prevention
  1. Jan Bornschein1,
  2. Massimo Rugge2,3
  1. 1 Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Medicine (DIMED), Pathology Unit, University of Padova, Padova, Italy
  3. 3 Veneto Tumor Registry (RTV), Padova, Italy
  1. Correspondence to Dr Jan Bornschein, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; janbornschein{at}gmx.de

https://doi.org/10.1136/gutjnl-2020-321570

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    ‘Can we replace histology assessment (of gastritis) also in the West?’ is the question that Marcos et al ask readers of their interesting study conducted at the Portuguese Oncology Institute in Porto.1 The study further examines the clinical value of the group’s promising approach to the endoscopic grading of gastric intestinal metaplasia (EGGIM) to facilitate the direct stratification of gastritis patients by their individual gastric cancer (GC) risk. The aim is to establish an endoscopy-based rationale for further endoscopic surveillance of patients at higher risk of GC. The authors conclude that endoscopy can reliably stratify GC risk. This would simplify everyday practice in terms of the GC risk assessment and management of patients with preneoplastic conditions, that is, glandular atrophy and intestinal metaplasia (IM).

    Any patient-centred cancer prevention should include a set of variables that can be classified according to their invasiveness, reliability and cost. In the setting of GC prevention, there are some firmly established clinicopathological variables: (1) country-specific epidemiology and the socioeconomic setting; (2) feasibility of testing and treating Helicobacter pylori, the leading causative agent; (3) the use of reliable biomarkers (including the so-called ‘gastric serology’ or assessment of serum pepsinogens, and more sophisticated molecular markers); (4) endoscopy (as the main source of …

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    Footnotes

    • Contributors Equal contribution of both authors to writing this article.

    • Funding This work was partly supported by a grant from the Italian Association for Cancer Research (AIRC Regional grant no 6421 to MR), and by the Italian Health Ministry’s research programme: 'Performance evaluation and value assessment for cardiovascular and oncological care path in a regional network context: challenges and opportunities' NET-2016–02363853.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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