Estratificação de risco para câncer gástrico durante o exame endoscópico

Abstract

Gastric cancer still represents a significant public health challenge, and its development is closely related to the presence of precursor lesions, such as intestinal atrophy and metaplasia. This study aims to analyze how endoscopic examination can be used in a standardized way to stratify the risk of gastric cancer, based on a thorough evaluation of the mucosa and its integration with histological findings. This is a literature review, conducted in databases such as PubMed, complemented by guidelines from specific medical societies in the field. The synthesis of the data allowed the topic to be organized into three main axes: endoscopic, histological, and surveillance. In the endoscopic evaluation, the importance of the quality of the examination stands out, as well as new endoscopic techniques for improvement, in which the more accurate visualization and characterization of lesions allow for risk stratification according to the extent of atrophy and metaplasia. In the histological axis, the extent of metaplasia and atrophy are confirmed as highly predictive of a higher risk of progression to gastric neoplasia. Based on these two elements, surveillance strategies are adopted depending on risk stratification. It is concluded that adopting a stratification structure can reduce variability in management, avoid underdiagnosis of high-risk patients, and strengthen endoscopy as an essential tool in the prevention and surveillance of gastric neoplasia.