Article Text

Download PDFPDF

British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma
  1. Matthew Banks1,2,
  2. David Graham1,3,
  3. Marnix Jansen4,
  4. Takuji Gotoda5,
  5. Sergio Coda6,
  6. Massimiliano di Pietro7,8,
  7. Noriya Uedo9,
  8. Pradeep Bhandari10,
  9. D Mark Pritchard11,
  10. Ernst J Kuipers12,
  11. Manuel Rodriguez-Justo4,
  12. Marco R Novelli4,
  13. Krish Ragunath13,
  14. Neil Shepherd14,
  15. Mario Dinis-Ribeiro15
  1. 1 University College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2 Research Department of Targeted Intervention, University College London, London, UK
  3. 3 Division of Surgery and Interventional Science, University College London Division of Biosciences, London, UK
  4. 4 Department of Histopathology, University College London, London, UK
  5. 5 Gastroenterology, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
  6. 6 Endoscopy, Inhealth Group, London, UK
  7. 7 MRC Cancer Unit, University of Cambridge, Cambridge, UK
  8. 8 Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  9. 9 Department of Gastrointestinal Oncology, Endoscopic Training and Learning Center, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
  10. 10 Gastroenterology, Portsmouth, Portsmouth, UK
  11. 11 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  12. 12 Erasmus University Medical Center, Rotterdam, Netherlands
  13. 13 Nottingham Digestive Diseases Centre, Nottingham University Hospital, Nottingham, UK
  14. 14 Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK
  15. 15 Gastroenterology, IPO Porto, Porto, Portugal
  1. Correspondence to Dr Matthew Banks, University College London Hospital, University College London Hospitals NHS Foundation Trust, London NW12PG, UK; matthew.banks2{at}


Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis. Risk factors include Helicobacter pylori infection, family history of gastric cancer—in particular, hereditary diffuse gastric cancer and pernicious anaemia. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. High-quality endoscopy with full mucosal visualisation is an important part of improving early detection. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met.

  • gastric adenocarcinoma
  • gastric pre-cancer
  • gastritis
  • helicobacter pylori-gastritis
  • endoscopy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors Each coauthor’s contribution was dependent upon their role in the subgroups and varied across the guideline development group.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    This guidelines was supported by the BSG for meetings only

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators Marc Tischkowitz.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.