Patient with multifocal low grade dysplasia of the antrum, on the basis of persistent helicobacter pylori infection. The lesion was located close to the pylorus, which makes the dissection somehow tricky.
Why the prepyloric antrum is unforgiving
The space narrows towards the pylorus and the angulation makes the endoscope harder to hold steady. Worse, the stomach moves: peristalsis and respiration are transmitted directly to the lesion, so the working field shifts under the knife. Control of that movement is most of the work.
Why margins matter more here
Gastric dysplasia arises in mucosa that is already altered by atrophy and intestinal metaplasia. The visible lesion is frequently the tip of a wider field, and its true borders extend beyond what white light shows. That is why delineation precedes resection, and why the specimen must arrive in one piece for the margins to mean anything.
Gastric dysplasia arising from Helicobacter pylori
Chronic infection produces atrophic gastritis and intestinal metaplasia, which can progress to dysplasia and ultimately gastric cancer. Removing the dysplastic lesion interrupts that sequence at an early stage.
Why the prepyloric location is demanding
The prepyloric space is narrow, angulation makes the endoscope harder to stabilise, and movement of the organ is transmitted to the lesion. Good control of the field is required so that dissection stays in the correct plane without breaching the muscularis.
After the resection
The specimen is sent for histology, and it is that report rather than the endoscopic appearance that determines the next step. Surveillance intervals are set by guideline and individualised per case; they are set out in detail on the page for colonoscopy.
Frequently asked questions
Is surveillance needed after removing gastric dysplasia?
Yes. The remaining mucosa is still affected by atrophy and intestinal metaplasia, so the risk of a new lesion does not disappear. Eradication of Helicobacter pylori follows where present, together with scheduled endoscopic surveillance and targeted biopsies.
Sources
- European Society of Gastrointestinal Endoscopy, Post-polypectomy colonoscopy surveillance: ESGE Guideline Update 2020. https://doi.org/10.1055/a-1185-3109
Content last updated: September 2026 (14/09/2026).
