Endoscopic Treatment of Gastric Adenoma

Cheal Wung Huh; Byung-Wook Kim

doi:10.4166/kjg.2017.70.3.115

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Huh and Kim: Endoscopic Treatment of Gastric Adenoma

Review Article

Korean J Gastroenterol 2017;70(3):115-120.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.3.115

Endoscopic Treatment of Gastric Adenoma

Cheal Wung Huh, Byung-Wook Kim

Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

Correspondence to: Byung-Wook Kim, Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea. Tel: +82-32-280-5052, Fax: +82-32-280-5987, E-mail: gastro@catholic.ac.kr

Received 9 August 2017 Revised 1 September 2017 Accepted 5 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastric adenoma (dysplasia) is a precancerous lesion. Therefore, managements of gastric adenomas are important for preventing the development of gastric cancers and for detecting gastric cancers at earlier stages. The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia. Generally, endoscopic resection is performed for adenoma with high-grade dysplasia due to the coexistence of carcinoma and the potential of progression to carcinomas. However, the treatments of adenoma with low-grade dysplasia remain controversial. Currently two treatment strategies for the low-grade type have been suggested; First is the ‘wait and see' strategy; Second is endoscopic treatment (e.g., endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation). In this review, we discuss the current optimal strategies for endoscopic management of gastric adenoma.

Keywords: Gastric adenoma, Dysplasia, Endoscopic treatment

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Fig. 1.

Proposed treatment strategy algorithm for gastric adenoma diagnosed by endoscopic biopsy; ^* low risk lesion: size<2 cm, grossly flat type, whitish color with smooth surface; ^† high risk lesion: size≥2 cm, grossly depressed type, surface erythema or unevenness, presence of spontaneous bleeding. EMR, endoscopic mucosal resection; APC, argon plasma coagulation; ESD, endoscopic submucosal dissection.

Table 1.

Classification Systems of Gastric Epithelial Neoplasia

Revised Vienna¹⁵	Japanese⁵⁶	WHO⁵⁷
Category 1: Negative for dysplasia	Group I: Normal or benign	No intraepithelial neoplasia/dysplasia
Category 2: Indefinite for dysplasia	Group II: Benign with atypia	Indefinite for intraepithelial neoplasia/dysplasia
Category 3: Mucosal low-grade neoplasia	Group III: Borderline	Low-grade intrae pithelial neoplasia/dysplasia
(low-grade adenoma/dysplasia)
Category 4: Mucosal high-grade neoplasia	Group IV: Strongly suspicious for invasive carcinoma	High-grade intraepithelial neoplasia/dysplasia
4.1: High-grade adenoma/dysplasia
4.2: Noninvasive carcinoma (CIS)
4.3: Suspicious for invasive carcinoma
4.4: Intramucosal carcinoma
Category 5: Submucosal invasion by carcinoma	Group V: Definitive for invasive carcinoma	Intramucosal invasive carcinoma

WHO, World Health Organization; CIS, carcinoma in situ.

Table 2.

Treatment Outcomes and Complications of Endoscopic Mucosal Resection for Gastric Adenoma

Author	Year	Number of patients	Complete resection rate (%)	En bloc resection rate (%)	Procedure time (mins)	Complication		Local recurrence (%)
Author	Year	Number of patients	Complete resection rate (%)	En bloc resection rate (%)	Procedure time (mins)	Bleeding (%)	Perforation (%)	Local recurrence (%)
Kim et al.⁵⁸	2012	196	86.7	31.1	10.8±13.4	1.5	0	2.6
Park et al.⁵⁹	2015	158	90.5	91.1	9	1.3	1.3	2.2

Table 3.

Treatment Outcomes and Complications of Endoscopic Submucosal Dissection for Gastric Adenoma

Author	Year	Number of patients	Complete resection rate (%)	En bloc resection rate (%)	Procedure time (mins)	Complication		Local recurrence (%)
Author	Year	Number of patients	Complete resection rate (%)	En bloc resection rate (%)	Procedure time (mins)	Bleeding (%)	Perforation (%)	Local recurrence (%)
Kato et al.²⁴	2011	468	97.0	97.0	59.0	5.4	4.3	N/A
Choi et al.⁶⁰	2012	282	96.1	N/A	26.4	1.4	0	1.4
Kim et al.⁵⁸	2012	56	98.2	75.0	43.1±23.7	10.7	0	1.8
Jung et al.⁴⁶	2012	204	95.4	91.7	53.1±38.1	2	1	0.5
Lee et al.⁴⁸	2017	113	89.4	100	N/A	5.3	0.9	3.5

N/A, not available.

Table 4.

Treatment Outcomes and Complications of Argon Plasma Coagulation for Gastric Adenoma

Author	Year	Number of patients	Hospital days	Need to admission (%)	Procedure time (mins)	Complication		Local recurrence (%)
Author	Year	Number of patients	Hospital days	Need to admission (%)	Procedure time (mins)	Bleeding (%)	Perforation (%)	Local recurrence (%)
Lee et al.⁴⁸	2009	57	N/A	N/A	15.0±5.0	1.7	1.7	7.0
Jung et al.⁴⁶	2013	116	1.2±2.3	31	7.8±5.1	1.7	0	3.8
Ahn et al.⁴⁷	2013	71	N/A	N/A	N/A	1.4	0	21.1
Lee et al.⁴⁵	2017	97	1.6±2.0	42	N/A	0	0	15.3

N/A, not available.

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