Gastric cancer remains one of the most common and deadly cancers worldwide, especially among older males. According to GLOBOCAN 2018 data, stomach cancer is the 5th most common neoplasm and the 3rd leading cause of cancer deaths worldwide, following only lung and colorectal cancer in overall mortality, with an estimated 783,000 deaths in 2018. About 1 in 12 of all oncological deaths are attributable to gastric cancer. Gastric cancer incidence and mortality are highly variable by region and highly dependent on diet and Helicobacter pylori infection. In most developed countries, however, gastric cancer rates have declined dramatically over the past half-century due to the changes in the social environment and lower rates of Helicobacter pylori gastritis in Western countries. In Russia, gastric cancer is the 6th most common cancer and 2nd leading cause of cancer deaths. The rates remain high despite a twofold decrease. Early detection of cancer or their precursors may be the only chance to reduce this high mortality. Patients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk stratification for these patients. There is a wide disparity in the management of patients with these premalignant conditions in the absence of guidelines. ESGE recently published the updated guidelines on managing patients with Precancerous conditions and lesions of the Stomach (MAPS II). Conventional white-light endoscopy sometimes is limited to detecting and accurately differentiating pre-neoplastic gastric conditions and lesions based on gross morphological changes, while new optically based technologies with high resolution offer the potential of detecting the very earliest mucosal changes at the microstructural level. Besides, at least four biopsies of the proximal and distal stomach, on lesser and greater curvature, are needed for adequate assessment of premalignant gastric conditions and systems for histopathological staging (e.g., OLGA and OLGIM). The diagnostic algorithm for modern screening upper gastrointestinal endoscopy, including the main steps of the procedure may be useful for detection and characterization of minute mucosal changes. Patients with advanced stages of atrophic gastritis should be followed up with a high-quality endoscopy every three years. In patients with dysplasia, in the absence of an endoscopically defined lesion, immediate high-quality endoscopic reassessment with chromoendoscopy is recommended. Patients with an endoscopically visible lesion harboring low or high-grade dysplasia or carcinoma should undergo staging and treatment. H. pylori eradication heals nonatrophic chronic gastritis, may lead to regression of atrophic gastritis and reduces the risk of gastric cancer in patients with these conditions, and it is recommended. H.pylori eradication is also recommended for patients with neoplasia after endoscopic therapy. In intermediate to high-risk regions, identification and surveillance of patients with precancerous gastric conditions are cost-effective. If Helicobacter pylori infection is present, eradication should be offered to prevent high-grade dysplasia or carcinoma.
