At a population level, the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), and the European Society of Pathology (ESP) suggest endoscopic screening for gastric cancer (and precancerous conditions) in high-risk regions (age-standardized rate [ASR] > 20 per 100 000 person-years) every 2 to 3 years or, if cost-effectiveness has been proven, in intermediate risk regions (ASR 10-20 per 100 000 person-years) every 5 years, but not in low-risk regions (ASR < 10).ESGE/EHMSG/ESP recommend that irrespective of country of origin, individual gastric risk assessment and stratification of precancerous conditions is recommended for first-time gastroscopy. ESGE/EHMSG/ESP suggest that gastric cancer screening or surveillance in asymptomatic individuals over 80 should be discontinued or not started, and that patients' comorbidities should be considered when treatment of superficial lesions is planned.ESGE/EHMSG/ESP recommend that a high quality endoscopy including the use of virtual chromoendoscopy (VCE), after proper training, is performed for screening, diagnosis, and staging of precancerous conditions (atrophy and intestinal metaplasia) and lesions (dysplasia or cancer), as well as after endoscopic therapy. VCE should be used to guide the sampling site for biopsies in the case of suspected neoplastic lesions as well as to guide biopsies for diagnosis and staging of gastric precancerous conditions, with random biopsies to be taken in the absence of endoscopically suspected changes. When there is a suspected early gastric neoplastic lesion, it should be properly described (location, size, Paris classification, vascular and mucosal pattern), photodocumented, and two targeted biopsies taken.ESGE/EHMSG/ESP do not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection unless there are signs of deep submucosal invasion or if the lesion is not considered suitable for endoscopic resection.ESGE/EHMSG/ESP recommend endoscopic submucosal dissection (ESD) for differentiated gastric lesions clinically staged as dysplastic (low grade and high grade) or as intramucosal carcinoma (of any size if not ulcerated or ≤ 30 mm if ulcerated), with EMR being an alternative for Paris 0-IIa lesions of size ≤ 10 mm with low likelihood of malignancy.ESGE/EHMSG/ESP suggest that a decision about ESD can be considered for malignant lesions clinically staged as having minimal submucosal invasion if differentiated and ≤ 30 mm; or for malignant lesions clinically staged as intramucosal, undifferentiated and ≤ 20 mm; and in both cases with no ulcerative findings.ESGE/EHMSG/ESP recommends patient management based on the following histological risk after endoscopic resection: Curative/very low-risk resection (lymph node metastasis [LNM] risk < 0.5 %-1 %): en bloc R0 resection; dysplastic/pT1a, differentiated lesion, no lymphovascular invasion, independent of size if no ulceration and ≤ 30 mm if ulcerated. No further staging procedure or treatment is recommended.Curative/low-risk resection (LNM risk < 3 %): en bloc R0 resection; lesion with no lymphovascular invasion and: a) pT1b, invasion ≤ 500 µm, differentiated, size ≤ 30 mm; or b) pT1a, undifferentiated, size ≤ 20 mm and no ulceration. Staging should be completed, and further treatment is generally not necessary, but a multidisciplinary discussion is required. Local-risk resection (very low risk of LNM but increased risk of local persistence/recurrence): Piecemeal resection or tumor-positive horizontal margin of a lesion otherwise meeting curative/very low-risk criteria (or meeting low-risk criteria provided that there is no submucosal invasive tumor at the resection margin in the case of piecemeal resection or tumor-positive horizontal margin for pT1b lesions [invasion ≤ 500 µm; well-differentiated; size ≤ 30 mm, and VM0]). Endoscopic surveillance/re-treatment is recommended rather than other additional treatment. High-risk resection (noncurative): Any lesion with any of the following: (a) a positive vertical margin (if carcinoma) or lymphovascular invasion or deep submucosal invasion (> 500 µm from the muscularis mucosae); (b) poorly differentiated lesions if ulceration or size > 20 mm; (c) pT1b differentiated lesions with submucosal invasion ≤ 500 µm with size > 30 mm; or (d) intramucosal ulcerative lesion with size > 30 mm. Complete staging and strong consideration for additional treatments (surgery) in multidisciplinary discussion.ESGE/EHMSG/ESP suggest the use of validated endoscopic classifications of atrophy (e. g. Kimura-Takemoto) or intestinal metaplasia (e. g. endoscopic grading of gastric intestinal metaplasia [EGGIM]) to endoscopically stage precancerous conditions and stratify the risk for gastric cancer.ESGE/EHMSG/ESP recommend that biopsies should be taken from at least two topographic sites (2 biopsies from the antrum/incisura and 2 from the corpus, guided by VCE) in two separate, clearly labeled vials. Additional biopsy from the incisura is optional.ESGE/EHMSG/ESP recommend that patients with extensive endoscopic changes (Kimura C3 + or EGGIM 5 +) or advanced histological stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia, or changes in both antrum and corpus, operative link on gastritis assessment/operative link on gastric intestinal metaplasia [OLGA/OLGIM] III/IV) should be followed up with high quality endoscopy every 3 years, irrespective of the individual's country of origin.ESGE/EHMSG/ESP recommend that no surveillance is proposed for patients with mild to moderate atrophy or intestinal metaplasia restricted to the antrum, in the absence of endoscopic signs of extensive lesions or other risk factors (family history, incomplete intestinal metaplasia, persistent H. pylori infection). This group constitutes most individuals found in clinical practice.ESGE/EHMSG/ESP recommend H. pylori eradication for patients with precancerous conditions and after endoscopic or surgical therapy.ESGE/EHMSG/ESP recommend that patients should be advised to stop smoking and low-dose daily aspirin use may be considered for the prevention of gastric cancer in selected individuals with high risk for cardiovascular events.

在人群层面，欧洲胃肠内镜学会（ESGE）、欧洲螺旋杆菌和微生物研究小组（EHMSG）和欧洲病理学学会（ESP）建议，在高风险地区（年龄标准化率[ASR]>20/100 000人-年），每2至3年进行一次胃癌（和癌前病变）内镜筛查，或在中风险地区（年龄标准化率[ASR]10-20/100 000人-年），每5年进行一次胃癌（和癌前病变）内镜筛查、 如果成本效益得到证实，在中危地区（年龄标准化比率为每 10 万人年 10-20 例）每 5 年进行一次，但在低危地区（年龄标准化比率小于 10 例）则不进行。 ESGE/EHMSG/ESP 建议，无论原籍国如何，首次胃镜检查都应进行个体胃癌风险评估和癌前病变分层。ESGE/EHMSG/ESP 建议对 80 岁以上无症状者停止或不开始胃癌筛查或监测，在计划治疗浅表病变时应考虑患者的合并症。 ESGE/EHMSG/ESP 建议在经过适当培训后进行高质量的内镜检查，包括使用虚拟色内镜 (VCE)，以便对癌前病变（萎缩和肠化生）和病变（发育不良或癌症）进行筛查、诊断和分期，以及在内镜治疗后进行筛查、诊断和分期。在怀疑有肿瘤病变的情况下，VCE 应用于指导活检的取样部位，以及指导活检用于胃癌前病变的诊断和分期，在没有镜疑似病变的情况下，可随机进行活检。当怀疑有早期胃肿瘤病变时，应适当描述病变（位置、大小、巴黎分类、血管和粘膜形态），拍照记录，并进行两次有针对性的活检。 ESGE/EHMSG/ESP 不建议在内镜切除前常规进行内镜超声波检查 (EUS)、计算机断层扫描 (CT)、磁共振成像 (MRI) 或正电子发射断层扫描 (PET)，除非有粘膜下深层侵犯的迹象或认为病变不适合内镜切除。 ESGE/EHMSG/ESP 建议对临床分期为发育不良（低度和高度）或粘膜内癌（未溃疡的任何大小或溃疡的≤30 毫米）的分化型胃病变进行内镜下粘膜下剥离术（ESD），对于恶性可能性较低、大小≤10 毫米的 Paris 0-IIa 病变，可选择 EMR。 ESGE/EHMSG/ESP 建议，对于临床分期为粘膜下微创（如果已分化）且≤ 30 mm 的恶性病变，或临床分期为粘膜内、未分化且≤ 20 mm 的恶性病变，以及两种情况下均无溃疡发现的恶性病变，可考虑决定是否进行 ESD。ESGE/EHMSG/ESP 建议根据内镜切除术后的以下组织学风险对患者进行管理： 根治性/极低风险切除（淋巴结转移[LNM]风险< 0.5 %-1 %）：整体R0切除；发育不良/pT1a，分化性病变，无淋巴管侵犯，如无溃疡则与大小无关，如有溃疡则≤30 mm。治愈性/低风险切除术（LNM 风险< 3%）：整块 R0 切除术；病灶无淋巴管侵犯，且：a) pT1b，侵犯≤ 500 µm，已分化，大小≤ 30 mm；或 b) pT1a，未分化，大小≤ 20 mm 且无溃疡。应完成分期，一般无需进一步治疗，但需要进行多学科讨论。局部风险切除术（发生 LNM 的风险很低，但局部持续存在/复发的风险增加）： 对符合治愈/极低风险标准的病灶进行零星切除或肿瘤阳性水平切缘（或符合低风险标准，但在对 pT1b 病灶进行零星切除或肿瘤阳性水平切缘的情况下，切除边缘无粘膜下浸润性肿瘤[浸润≤ 500 µm；分化良好；大小≤ 30 mm，且 VM0]）。建议进行内窥镜监测/再治疗，而不是其他额外治疗。高风险切除术（非治愈性）： 具有以下任何一种情况的病灶： (a) 垂直边缘阳性（如果是癌）或淋巴管侵犯或粘膜下深层侵犯（距离粘膜肌> 500 µm）；(b) 如果溃疡或大小> 20 mm，则为分化不良病变；(c) pT1b 分化病变，粘膜下侵犯≤ 500 µm，大小> 30 mm；或 (d) 粘膜内溃疡性病变，大小> 30 mm。在多学科讨论中进行完整的分期，并着重考虑额外的治疗（手术）。ESGE/EHMSG/ESP 建议使用经过验证的萎缩（如木村-竹本）或肠化生（如胃肠化生内镜分级 [EGGIM]）内镜分类，对癌前病变进行内镜分期，并对胃癌风险进行分层。 ESGE/EHMSG/ESP 建议至少应在两个地形部位取活检样本（在 VCE 引导下，从胃窦/切口和胃体各取 2 份活检样本），分别装在两个贴有明确标签的小瓶中。切口的额外活检是可选的。 ESGE/EHMSG/ESP 建议，有广泛内镜病变（Kimura C3 + 或 EGGIM 5 +）或萎缩性胃炎组织学晚期（严重萎缩性病变或肠化生，或胃窦和胃体均有病变，胃炎评估/胃肠化生手术链接 [OLGA/OLGIM] III/IV）的患者，无论原籍国如何，均应每 3 年进行一次高质量的内镜随访。 ESGE/EHMSG/ESP 建议，对于轻度至中度萎缩或肠化生仅限于胃窦部的患者，如果没有广泛病变的内镜征象或其他风险因素（家族史、不完全肠化生、幽门螺杆菌持续感染），则不建议进行监测。ESGE/EHMSG/ESP 建议癌前病变患者以及接受内镜或手术治疗后的患者根除幽门螺杆菌。ESGE/EHMSG/ESP 建议应建议患者戒烟，对于心血管事件高危人群，可考虑每天服用小剂量阿司匹林来预防胃癌