Editorial
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Pathophysiol. Dec 15, 2011; 2(6): 93-99
Published online Dec 15, 2011. doi: 10.4291/wjgp.v2.i6.93
Treatment strategy for gastric non-invasive intraepithelial neoplasia diagnosed by endoscopic biopsy
Tsutomu Nishida, Shusaku Tsutsui, Motohiko Kato, Takuya Inoue, Shunsuke Yamamoto, Yoshito Hayashi, Tomofumi Akasaka, Takuya Yamada, Shinichiro Shinzaki, Hideki Iijima, Masahiko Tsujii, Tetsuo Takehara
Tsutomu Nishida, Shusaku Tsutsui, Motohiko Kato, Takuya Inoue, Shunsuke Yamamoto, Yoshito Hayashi, Tomofumi Akasaka, Takuya Yamada, Shinichiro Shinzaki, Hideki Iijima, Masahiko Tsujii, Tetsuo Takehara, Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
Author contributions: Nishida T wrote the manuscript; Nishida T, Tsusui S and Kato M researched the content; Inoue T, Yamamoto S, Hayashi Y, Akasaka T, Yamada T and Shinzaki S contributed equally to this work; Iijima H, Tsujii M and Takehara T provided scientific editing and assisted with writing the manuscript.
Correspondence to: Tetsuo Takehara, MD, PhD, Department of Gastroenterology and Hepatology, Clinical Research Building (K1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. takehara@gh.med.osaka-u.ac.jp
Telephone: +81-6-68793621 Fax: +81-6-68793629
Received: May 2, 2011
Revised: September 26, 2011
Accepted: October 3, 2011
Published online: December 15, 2011
Abstract

Treatment strategies, whether as follow-up or “total incisional biopsy” for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen, are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment. Based on the histological findings of the biopsy specimen, it is difficult to differentiate between reactive or regenerative changes, inflammation and neoplastic changes, intraepithelial and invasive tumors. Therefore, gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and high-frequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection (ESD), a therapeutic option for gastric intraepithelial neoplasia, including low-grade neoplasms. Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.

Keywords: Gastric intraepithelial neoplasia; Adenoma; Dysplasia; Endoscopic submucosal dissection; Endoscopic mucosal resection; Endoscopic resection; Adenocarcinoma