Gastric Intestinal Metaplasia Consultant for: and Early Gastric - PDF document

Disclosures Gastric Intestinal Metaplasia • Consultant for: and Early Gastric Cancer: – Olympus Screening, Surveillance, and – Medtronic Endoscopic Therapy – US Endoscopy Joo Ha Hwang, MD, PhD Associate Professor of Medicine Chief, Gastroenterology Harborview Medical Center University of Washington, Seattle 6 th Annual Asian Health Symposium, UCSF Friday, October 6, 2017 Objectives AS GE Guidelines • We suggest screening EGD for gastric cancer in new Discuss: U.S . immigrants from high-risk regions around the world, such as Korea, Japan, China, Russia, and S outh • Which patients should be considered for gastric America, especially if there is a family history of gastric cancer screening cancer in a first-degree relative. • How to perform gastric cancer screening • What intervals should screening be performed Stomach cancer • What to do when an early gastric cancer is is the 3 rd leading cause suspected of cancer death worldwide • Endoscopy resection vs. surgery Race and ethnicity considerations in GI Ethnic issues in endoscopy (ASGE SOP) 2010 Endoscopy - GIE 2015

Incidence of Gastric Cancer Cancer Incidence S tomach and Colorectal Cancer (men) 2004-2009 Korea vs. US ���������������������� 500 450 ���������� ���� 400 Incidence (per 100,000) ������ ���� Korean-Stomach 350 Cancer 300 ����������������� ����� 250 Korean-Colorectal Cancer 200 ���������������������������� ����� 150 US-Colorectal Cancer 100 ������������������� ����� 50 US-Stomach Cancer 0 ����������������� ����� Age http://seer.cancer.gov/statfacts/html/stomach.html http://globocan.iarc.fr Lin Gomez et al. J Natl Cancer Inst 2013 WHO – GLOBOCAN 2012 US vs. Korea Is screening effective? S tage Distribution and Relative S urvival Rates • S creening programs in Japan and Korea ������������������ ��������������� have increased survival for gastric CA ������ ������ ��������� ������������� ����������� ������������� ����������� 5 year survival ���������� ���� ���� ���� ���� 80 70 ���������� � ��� ����� � ��� ����� 60 67 62.1 50 57.7 ��������� ��� ����� ��� ����� 40 30 20 26.9 �������� ��� ���� ��� ���� 10 0 �������� ��� ����� ��� ����� ����������� ���� � ����� ���� � ����� Jung et al. Cancer Res Treat 2013

Endoscopy of GIM What is gastric intestinal Correa’s Cascade metaplasia? � Precancerous lesion for gastric cancer – Gastric CA is the 3 nd leading cause of cancer death worldwide – High incidence in eastern Asia, eastern Europe, and S . America � GIM has increase risk of gastric cancer if it occurs in the setting of atrophic gastritis – Patients with IM have 6-8 fold increased risk of gastric cancer � IM does not regress following h. pylori therapy – May slow progression � Additional risk factors – Incomplete-type IM – Both antral and body involvement – IM involving over 20% of the gastric mucosa – Family history (1 st degree relative) Peleteiro and Lunet (2011) – S moking http://www.intechopen.com/books/gastritis-and-gastric-cancer-new-insights-in-gastroprotection-diagnosis- and-treatments/role-of-genetic-and-environmental-risk-factors-in-gastric-carcinogenesis-pathway

AS GE Guideline Management of premalignant and malignant conditions of the stomach GIE 2015 • “ We suggest surveillance endoscopy for patients with GIM who are at increased risk of gastric cancer due to ethnic background or family history. Optimal surveillance intervals have not been extensively studies and should be individualized.” • “ We recommend endoscopic resection and surveillance endoscopy for patients with confirmed GIM with HGD when feasible.” Kim, Liang, Bang and Hwang, Screening and Surveillance for Gastric cancer in the United States: Is it needed? GIE 2016

Criteria for ESD/Surgery ESD ������������������ �������������� ������ ��������� ������ �������� �������� ������������� ������ ������ ������ ������ ������ ��������� ����� ��������������� ���� ���� �������� ���� �������� ���� ����������������� ���� �������� �������� �������� �������� �������� Accepted criteria for endoscopic resection (EMR/ESD) Expanded criteria for endoscopic resection (EMR/ESD) Absolute criteria for surgery ESD ESD Video

Resected specimen ESD vs Surgery for EGC Chiu et al. Surg Endosc 2012 Who’s at risk? Perioperative Results ESD Gastrectomy P value N=74 N-40 Median operating 90 265 <0.001 time (range) (45-360) (150-360) Median hospital 3.0 9.9 <0.001 stay (range) (2-10) (6-26) Overall 5.4% 32.5% <0.001 complication rate Chiu et al. Surg Endosc 2012;26:3584-3591

Summary Thank you • Gastric intestinal metaplasia is a premalignant lesion. • Surveillance of GIM should be performed in patients who have extensive GIM or have additional risk factors for gastric cancer. • HGD and early gastric cancer can be managed endoscopically without the need for surgery