{"id":10527,"date":"2025-10-09T06:30:00","date_gmt":"2025-10-09T09:30:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=10527"},"modified":"2025-10-08T23:27:58","modified_gmt":"2025-10-09T02:27:58","slug":"ha-evidencia-para-rastreio-de-cancer-gastrico-quando-realizar","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/ha-evidencia-para-rastreio-de-cancer-gastrico-quando-realizar\/","title":{"rendered":"H\u00e1 evid\u00eancia para rastreio de c\u00e2ncer g\u00e1strico? Quando realizar?"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/10527?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/10527?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<p>O c\u00e2ncer g\u00e1strico continua sendo um desafio relevante na gastroenterologia. <a href=\"https:\/\/www.esge.com\/management-of-epithelial-precancerous-conditions-and-early-neoplasia-of-the-stomach-maps-iii-esge-ehmsg-esp-guideline-update-2025\">O&nbsp;<strong>novo <\/strong><em><strong>guideline<\/strong><\/em><strong> europeu MAPS III (<\/strong><em><strong>Management of epithelial precancerous conditions and early neoplasia of the stomach<\/strong><\/em><strong>) <\/strong><\/a> publicado em 2025 pela&nbsp;<strong>ESGE, EHMSG e ESP<\/strong>, atualizou as recomenda\u00e7\u00f5es sobre rastreamento, diagn\u00f3stico e manejo das condi\u00e7\u00f5es pr\u00e9-cancerosas g\u00e1stricas e do c\u00e2ncer g\u00e1strico precoce.<\/p>\n\n\n\n<p>Neste artigo, revisamos as&nbsp;recomenda\u00e7\u00f5es sobre o&nbsp;<strong>rastreamento do c\u00e2ncer g\u00e1strico<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-1-conceitos-iniciais\"><br><strong>1. Conceitos iniciais<\/strong><\/h2>\n\n\n\n<p>Antes de definir quem rastrear, precisamos diferenciar alguns conceitos:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Rastreamento populacional:<\/strong> busca ativa em pessoas&nbsp;assintom\u00e1ticas da popula\u00e7\u00e3o geral.<\/li>\n\n\n\n<li><strong>Rastreamento direcionado:<\/strong> feito em&nbsp;grupos de alto risco previamente definidos, como indiv\u00edduos com&nbsp;hist\u00f3rico familiar ou s\u00edndromes heredit\u00e1rias.<\/li>\n\n\n\n<li><strong>Rastreamento oportun\u00edstico:<\/strong> ocorre durante uma&nbsp;endoscopia realizada por outro motivo, aproveitando o exame para&nbsp;avaliar o risco individual&nbsp;e identificar&nbsp;condi\u00e7\u00f5es pr\u00e9-cancerosas&nbsp;(atrofia, metaplasia intestinal).<\/li>\n\n\n\n<li><strong>Vigil\u00e2ncia:<\/strong> refere-se ao&nbsp;acompanhamento endosc\u00f3pico peri\u00f3dico&nbsp;de pacientes que j\u00e1 t\u00eam les\u00f5es superficiais tratadas ou condi\u00e7\u00f5es pr\u00e9-cancerosas que exigem seguimento<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-2-rastreamento-populacional-em-quem-faz-sentido\"><br><strong>2. Rastreamento populacional: em quem faz sentido?<\/strong><\/h2>\n\n\n\n<p>O MAPS III refor\u00e7a que o rastreamento endosc\u00f3pico de c\u00e2ncer g\u00e1strico&nbsp;<strong>n\u00e3o deve ser universal<\/strong>, mas&nbsp;<strong>estratificado conforme o risco populacional<\/strong>, de acordo com a&nbsp;<strong>ASR (<\/strong><em><strong>age-standardized rate<\/strong><\/em><strong>, isto \u00e9, a taxa ajustada pela idade) \u2013 vide Tabela 1.<\/strong><\/p>\n\n\n\n<p>A ASR ajusta as taxas brutas de incid\u00eancia para a&nbsp;popula\u00e7\u00e3o mundial padr\u00e3o da OMS,&nbsp;permitindo compara\u00e7\u00f5es v\u00e1lidas entre pa\u00edses ao eliminar o efeito da idade. Em outras palavras: a taxa bruta de incid\u00eancia, apesar de mais pr\u00e1tica, \u00e9&nbsp;fortemente influenciada pela estrutura et\u00e1ria \u2014 regi\u00f5es com mais idosos ter\u00e3o taxas brutas maiores, mesmo que o risco individual de c\u00e2ncer seja o mesmo. A&nbsp;taxa ajustada (ASR) reflete o risco \u201cpuro\u201d de desenvolver a doen\u00e7a, independente do envelhecimento populacional.<\/p>\n\n\n\n<br>\n<p class=\"has-text-align-center\"><strong>Tabela 1:<\/strong> Recomenda\u00e7\u00f5es do MAPS III para rastreio populacionado de c\u00e2ncer g\u00e1strico, conforme ASR (taxa ajustada pela idade de incid\u00eancia de c\u00e2ncer g\u00e1strico).<\/p>\n\n\n\n<figure class=\"wp-block-table\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Categoria de risco<\/strong><\/td><td><strong>Crit\u00e9rio (ASR)<\/strong><\/td><td><strong>Recomenda\u00e7\u00e3o do MAPS III<\/strong><\/td><\/tr><tr><td><strong>Baixo risco<\/strong><\/td><td>&lt; 10\/100.000 habitantes\/ano<\/td><td>N\u00e3o rastrear<\/td><\/tr><tr><td><strong>Intermedi\u00e1rio<\/strong><\/td><td>10\u201320\/100.000 habitantes\/ano<\/td><td>Rastreio a cada 5 anos (se custo-efetivo e houver recursos)<\/td><\/tr><tr><td><strong>Alto risco<\/strong><\/td><td>&gt; 20\/100.000<\/td><td>Rastreio endosc\u00f3pico a cada 2\u20133<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-3-qual-e-a-evidencia\"><br><strong>3. Qual \u00e9 a evid\u00eancia?<\/strong><\/h2>\n\n\n\n<p>A maior parte das recomenda\u00e7\u00f5es tem&nbsp;<strong>n\u00edvel de evid\u00eancia moderado a baixo<\/strong>, refletindo a escassez de estudos randomizados fora da \u00c1sia. Entretanto, dados de coortes e programas populacionais (como o da Coreia do Sul) mostram redu\u00e7\u00e3o de&nbsp;<strong>20\u201340% na mortalidade por c\u00e2ncer g\u00e1strico<\/strong>&nbsp;em popula\u00e7\u00f5es submetidas a rastreamento endosc\u00f3pico peri\u00f3dico. O&nbsp;<strong>MAPS III<\/strong>, portanto, busca equilibrar&nbsp;<strong>benef\u00edcio populacional, custo e sustentabilidade<\/strong>&nbsp;da pr\u00e1tica endosc\u00f3pica.<\/p>\n\n\n\n<p>Embora o benef\u00edcio do rastreamento populacional do c\u00e2ncer g\u00e1strico em regi\u00f5es de risco intermedi\u00e1rio ainda n\u00e3o esteja totalmente estabelecido, estudos recentes apontam&nbsp;<strong>poss\u00edvel custo-efetividade quando o rastreamento endosc\u00f3pico \u00e9 integrado ao rastreamento colorretal<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-4-o-brasil-e-um-pais-de-risco-baixo-intermediario-ou-alto\"><br><strong>4. O Brasil \u00e9 um pa\u00eds de risco baixo, intermedi\u00e1rio ou alto?<\/strong><\/h2>\n\n\n\n<p>Sem considerar os tumores de pele n\u00e3o melanoma, o c\u00e2ncer de est\u00f4mago ocupa a quinta posi\u00e7\u00e3o entre os tipos de c\u00e2ncer mais frequentes no Brasil e no mundo.<\/p>\n\n\n\n<p>Segundo o&nbsp;<strong>INCA (Estimativas 2023-2025)<\/strong>, o Brasil apresenta&nbsp;<strong>taxa ajustada pela idade (ASR) de 9,51\/100.000 em homens<\/strong>&nbsp;e&nbsp;<strong>4,92\/100.000 em mulheres<\/strong>, determinando taxa ajustada pela idade geral de <strong>7,08\/100.000 habitantes, <\/strong>o que \u00e9 compat\u00edvel com <strong>risco baixo para c\u00e2ncer g\u00e1strico<\/strong>. Caso consider\u00e1ssemos a taxa bruta, ter\u00edamos 12,63 em homens, 7,36 em mulheres e 9,94\/100.000 na popula\u00e7\u00e3o geral.<\/p>\n\n\n\n<p>Assim, conforme o presente consenso, <strong>n\u00e3o se recomenda&nbsp;rastreamento populacional&nbsp;para c\u00e2ncer g\u00e1strico no pa\u00eds<\/strong>. Contudo, vivemos em um pa\u00eds continental heterog\u00eaneo e, conforme a Tabela 2, podemos observar que em alguns estados h\u00e1 risco intermedi\u00e1rio (principalmente na popula\u00e7\u00e3o masculina).<\/p>\n\n\n\n<br><p class=\"has-text-align-center\"><strong>Tabela 2:<\/strong> Estimativas de 2023 a 2025 de taxa ajustada pela idade (ASR) de c\u00e2ncer g\u00e1strico por unidade federativa (UF) no Brasil. Adaptado de INCA, 2022. (<a href=\"https:\/\/www.inca.gov.br\/publicacoes\/livros\/estimativa-2023-incidencia-de-cancer-no-brasil\">https:\/\/www.inca.gov.br\/publicacoes\/livros\/estimativa-2023-incidencia-de-cancer-no-brasil<\/a> )<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>UF<\/strong><\/td><td><strong>Estado<\/strong><\/td><td><strong>ASR Homens<\/strong><\/td><td><strong>ASR Mulheres<\/strong><\/td><td><strong>ASR Geral<\/strong><\/td><\/tr><tr><td>AC<\/td><td>Acre<\/td><td>9,74<\/td><td>4,61<\/td><td>7,08<\/td><\/tr><tr><td>AL<\/td><td>Alagoas<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">11,41<\/mark><\/td><td>4,47<\/td><td>7,49<\/td><\/tr><tr><td>AM<\/td><td>Amazonas<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">18,77<\/mark><\/td><td>8,51<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">13,42<\/mark><\/td><\/tr><tr><td>AP<\/td><td>Amap\u00e1<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">17,66<\/mark><\/td><td>8,18<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">12,85<\/mark><\/td><\/tr><tr><td>BA<\/td><td>Bahia<\/td><td>9,05<\/td><td>4,96<\/td><td>6,84<\/td><\/tr><tr><td>CE<\/td><td>Cear\u00e1<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">16,00<\/mark><\/td><td>7,58<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">11,34<\/mark><\/td><\/tr><tr><td>DF<\/td><td>Distrito Federal<\/td><td>9,12<\/td><td>3,72<\/td><td>5,93<\/td><\/tr><tr><td>ES<\/td><td>Esp\u00edrito Santo<\/td><td>8,85<\/td><td>3,99<\/td><td>5,98<\/td><\/tr><tr><td>GO<\/td><td>Goi\u00e1s<\/td><td>7,10<\/td><td>5,55<\/td><td>5,61<\/td><\/tr><tr><td>MA<\/td><td>Maranh\u00e3o<\/td><td>9,21<\/td><td>4,78<\/td><td>6,90<\/td><\/tr><tr><td>MG<\/td><td>Minas Gerais<\/td><td>5,75<\/td><td>2,41<\/td><td>3,86<\/td><\/tr><tr><td>MS<\/td><td>Mato Grosso do Sul<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">10,28<\/mark><\/td><td>5,55<\/td><td>7,31<\/td><\/tr><tr><td>MT<\/td><td>Mato Grosso<\/td><td>8,88<\/td><td>4,75<\/td><td>6,80<\/td><\/tr><tr><td>PA<\/td><td>Par\u00e1<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">17,20<\/mark><\/td><td>8,11<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">12,57<\/mark><\/td><\/tr><tr><td>PB<\/td><td>Para\u00edba<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">10,70<\/mark><\/td><td>5,26<\/td><td>7,66<\/td><\/tr><tr><td>PE<\/td><td>Pernambuco<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">10,09<\/mark><\/td><td>5,26<\/td><td>7,35<\/td><\/tr><tr><td>PI<\/td><td>Piau\u00ed<\/td><td>7,81<\/td><td>4,14<\/td><td>5,82<\/td><\/tr><tr><td>PR<\/td><td>Paran\u00e1<\/td><td>9,28<\/td><td>4,31<\/td><td>6,33<\/td><\/tr><tr><td>RJ<\/td><td>Rio de Janeiro<\/td><td>5,28<\/td><td>2,78<\/td><td>3,73<\/td><\/tr><tr><td>RN<\/td><td>Rio Grande do Norte<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">12,13<\/mark><\/td><td>6,52<\/td><td>9,03<\/td><\/tr><tr><td>RO<\/td><td>Rond\u00f4nia<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">11,78<\/mark><\/td><td>5,46<\/td><td>8,65<\/td><\/tr><tr><td>RR<\/td><td>Roraima<\/td><td>9,51<\/td><td>4,92<\/td><td>7,27<\/td><\/tr><tr><td>RS<\/td><td>Rio Grande do Sul<\/td><td>5,94<\/td><td>2,67<\/td><td>3,95<\/td><\/tr><tr><td>SC<\/td><td>Santa Catarina<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">15,69<\/mark><\/td><td>5,64<\/td><td>9,98<\/td><\/tr><tr><td>SE<\/td><td>Sergipe<\/td><td><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\">10,71<\/mark><\/td><td>4,96<\/td><td>7,47<\/td><\/tr><tr><td>SP<\/td><td>S\u00e3o Paulo<\/td><td>7,06<\/td><td>2,85<\/td><td>4,51<\/td><\/tr><tr><td>TO<\/td><td>Tocantins<\/td><td>8,84<\/td><td>3,74<\/td><td>6,33<\/td><\/tr><tr><td><strong>BR<\/strong><\/td><td><strong>Brasil<\/strong><\/td><td><strong>9,51<\/strong><\/td><td><strong>4,92<\/strong><\/td><td><strong>7,08<\/strong><\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<br><h2 class=\"wp-block-heading\" id=\"h-5-rastreio-oportunistico-uma-chance-que-deve-ser-aproveitada\"><strong>5. Rastreio oportun\u00edstico: uma chance que deve ser aproveitada<\/strong><\/h2>\n\n\n\n<p>Um dos pontos mais importantes do MAPS III \u00e9 a \u00eanfase no&nbsp;<strong>rastreamento oportun\u00edstico<\/strong>. A recomenda\u00e7\u00e3o \u00e9 que&nbsp;<strong>toda endoscopia digestiva alta inicial<\/strong>&nbsp;inclua a&nbsp;<strong>avalia\u00e7\u00e3o endosc\u00f3pica do risco individual<\/strong>&nbsp;de c\u00e2ncer g\u00e1strico \u2014 independentemente do pa\u00eds de origem do paciente.<\/p>\n\n\n\n<p>Isso significa que, mesmo em regi\u00f5es de risco baixo, como o Brasil, o endoscopista deve:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Avaliar atrofia e metaplasia intestinal;<\/li>\n\n\n\n<li>Coletar bi\u00f3psias em dois s\u00edtios anat\u00f4micos (antro\/incisura e corpo);<\/li>\n\n\n\n<li>Realizar&nbsp;<strong>diagn\u00f3stico e estratifica\u00e7\u00e3o de risco<\/strong>&nbsp;conforme OLGA\/OLGIM.<\/li>\n<\/ul>\n\n\n\n<p>Essa abordagem transforma a endoscopia em uma ferramenta de&nbsp;<strong>preven\u00e7\u00e3o secund\u00e1ria personalizada<\/strong>.<\/p>\n\n\n\n<br><h2 class=\"wp-block-heading\" id=\"h-6-rastreamento-direcionado\"><strong>6. Rastreamento direcionado<\/strong><\/h2>\n\n\n\n<p>O guideline prop\u00f5e duas estrat\u00e9gias de aten\u00e7\u00e3o especial aos familiares de primeiro grau de pacientes com c\u00e2ncer g\u00e1strico:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Triagem e erradica\u00e7\u00e3o n\u00e3o invasiva de <em>H. pylori<\/em> entre 20 e 30 anos<\/strong>;<\/li>\n\n\n\n<li><strong>Endoscopia aos 45 anos ou 10 anos antes da idade de diagn\u00f3stico do familiar afetado<\/strong>.<\/li>\n<\/ul>\n\n\n\n<p>Essas recomenda\u00e7\u00f5es refletem o reconhecimento do&nbsp;<strong>componente heredit\u00e1rio e familiar do risco g\u00e1strico<\/strong>, refor\u00e7ando a import\u00e2ncia de programas de rastreamento direcionado para esse grupo.<\/p>\n\n\n\n<p>As diretrizes brit\u00e2nicas (<strong>BSG<\/strong>) recomendam&nbsp;ainda <strong>rastreio endosc\u00f3pico direcionado<\/strong>&nbsp;em pacientes&nbsp;<strong>\u226550 anos<\/strong>&nbsp;com fatores de risco como&nbsp;<strong>anemia perniciosa, sexo masculino, tabagismo ou hist\u00f3rico familiar<\/strong>&nbsp;de c\u00e2ncer g\u00e1strico.<\/p>\n\n\n\n<br><h2 class=\"wp-block-heading\" id=\"h-7-quando-suspender-o-rastreamento\"><strong>7. Quando suspender o rastreamento?<\/strong><\/h2>\n\n\n\n<p>O benef\u00edcio do rastreamento do c\u00e2ncer g\u00e1strico diminui com o avan\u00e7o da idade e a presen\u00e7a de comorbidades, pois ambos reduzem a expectativa de vida e aumentam o risco de complica\u00e7\u00f5es associadas a procedimentos invasivos. Quando a expectativa de vida \u00e9&nbsp;<strong>inferior a 10 anos<\/strong>, o rastreamento \u00e9&nbsp;<strong>pouco prov\u00e1vel de trazer impacto significativo<\/strong>&nbsp;na sobrevida.<\/p>\n\n\n\n<p>Por isso, as diretrizes recomendam que o&nbsp;<strong>rastreamento ou vigil\u00e2ncia endosc\u00f3pica seja interrompido \u2014 ou nem iniciado \u2014 em indiv\u00edduos com mais de 80 anos<\/strong>&nbsp;ou cuja expectativa de vida seja claramente menor que 10 anos. Esse&nbsp;<strong>limite et\u00e1rio \u00e9 arbitr\u00e1rio<\/strong>, baseado na expectativa m\u00e9dia de vida e na baixa probabilidade de progress\u00e3o relevante das condi\u00e7\u00f5es pr\u00e9-cancerosas ap\u00f3s essa idade.<\/p>\n\n\n\n<br><h2 class=\"wp-block-heading\" id=\"h-8-marcadores-sericos-o-papel-do-pepsinogenio\"><strong>8. Marcadores s\u00e9ricos: o papel do pepsinog\u00eanio<\/strong><\/h2>\n\n\n\n<p>Segundo presente consenso, a <strong>endoscopia est\u00e1 recomendada em indiv\u00edduos com n\u00edveis s\u00e9ricos baixos de pepsinog\u00eanio I ou rela\u00e7\u00e3o I\/II reduzida<\/strong>, especialmente se&nbsp;<strong>sorologia negativa para <em>H. pylori<\/em><\/strong>. Esses achados bioqu\u00edmicos indicam&nbsp;<strong>atrofia avan\u00e7ada da mucosa g\u00e1strica<\/strong>&nbsp;e, portanto, risco aumentado de c\u00e2ncer, justificando investiga\u00e7\u00e3o endosc\u00f3pica. A dosagem destes marcadores, contudo, n\u00e3o \u00e9 rotineira em nosso pa\u00eds.<br><\/p>\n\n\n\n<br><h1 class=\"wp-block-heading\" id=\"h-conclusoes-praticas-para-o-brasil\"><strong>Conclus\u00f5es pr\u00e1ticas para o Brasil<\/strong><\/h1>\n\n\n\n<ul class=\"wp-block-list\">\n<li>O&nbsp;<strong>Brasil \u00e9 um pa\u00eds de risco baixo<\/strong>: rastreamento populacional&nbsp;<strong>n\u00e3o \u00e9 indicado<\/strong>, mas o&nbsp;<strong>rastreio oportun\u00edstico<\/strong>&nbsp;durante endoscopias deve ser rotina.<\/li>\n\n\n\n<li><strong>Estratificar o risco individual<\/strong>&nbsp;por meio de&nbsp;<strong>achados endosc\u00f3picos <\/strong>e&nbsp;<strong>bi\u00f3psias dirigidas (OLGA\/OLGIM)<\/strong>&nbsp;\u00e9 fundamental para vigil\u00e2ncia<\/li>\n\n\n\n<li>Pacientes com&nbsp;<strong>hist\u00f3rico familiar<\/strong>&nbsp;de c\u00e2ncer g\u00e1strico merecem aten\u00e7\u00e3o especial, com&nbsp;<strong>teste e erradica\u00e7\u00e3o de <em>H. pylori<\/em><\/strong>&nbsp;e&nbsp;<strong>EDA direcionada<\/strong>.<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<br><h2 class=\"wp-block-heading\" id=\"h-referencias\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Dinis-Ribeiro M, et al.&nbsp;<em>Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): ESGE\/EHMSG\/ESP Guideline Update 2025.<\/em>&nbsp;<strong>Endoscopy.<\/strong>&nbsp;2025. DOI:&nbsp;<a href=\"https:\/\/doi.org\/10.1055\/a-2529-5025\">10.1055\/a-2529-5025<\/a><\/li>\n\n\n\n<li>Instituto Nacional de C\u00e2ncer (INCA).\u00a0<em>Estimativa 2023: incid\u00eancia de c\u00e2ncer no Brasil. <\/em>Rio de Janeiro: INCA; 2022. 160 p. ISBN 978-65-88517-10-9. Dispon\u00edvel em:\u00a0<a href=\"https:\/\/www.inca.gov.br\/publicacoes\/livros\/estimativa-2023-incidencia-de-cancer-no-brasil\">https:\/\/www.inca.gov.br\/publicacoes\/livros\/estimativa-2023-incidencia-de-cancer-no-brasil<\/a><\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-como-citar-este-artigo\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Lages RB. H\u00e1 evid\u00eancia para rastreio de c\u00e2ncer g\u00e1strico? Quando realizar? Gastropedia 2025, Vol II. Dispon\u00edvel em: https:\/\/gastropedia.pub\/pt\/gastroenterologia\/ha-evidencia-para-rastreio-de-cancer-gastrico-quando-realizar\/<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>O c\u00e2ncer g\u00e1strico continua sendo um desafio relevante na gastroenterologia. O&nbsp;novo guideline europeu MAPS III (Management of epithelial precancerous conditions and early neoplasia of the stomach) publicado em 2025 pela&nbsp;ESGE,&hellip;<\/p>\n","protected":false},"author":4165,"featured_media":10530,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[20,18],"tags":[],"ano":[413],"tipo":[121],"volume":[44],"class_list":["post-10527","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-estomago","category-gastroenterologia","ano-413","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>H\u00e1 evid\u00eancia para rastreio de c\u00e2ncer g\u00e1strico? 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