{"id":4269,"date":"2015-08-19T10:00:19","date_gmt":"2015-08-19T10:00:19","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/"},"modified":"2023-08-07T20:47:28","modified_gmt":"2023-08-07T20:47:28","slug":"o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/","title":{"rendered":"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago"},"content":{"rendered":"<h2><strong>Post realizado por: \u00a0Alex Baia Gualter Leite<\/strong><\/h2>\n<h3><strong>Resid\u00eancia de Gastroenterologia e Endoscopia Digestiva pela Escola Paulista de Medicina \/ UNIFESP.\u00a0M\u00e9dico endoscopista da Cl\u00ednica Gastro Diagn\u00f3stico, Vit\u00f3ria.<\/strong><\/h3>\n<p>O texto abaixo discorre sobre o papel da endoscopia nas les\u00f5es pr\u00e9-malignas (t\u00f3pico 1) e malignas (t\u00f3pico 2) do est\u00f4mago. \u00a0A fonte para refer\u00eancia \u00e9 o recente <a href=\"http:\/\/www.asge.org\/uploadedFiles\/Publications_(public)\/Practice_guidelines\/Endoscopy_premalignant_malignant_conditions.pdf\" target=\"_blank\" rel=\"noopener\">guideline da ASGE<\/a>\u00a0sobre esse tema.<\/p>\n<p>Abaixo tabela com os detalhes das recomenda\u00e7\u00f5es usadas no texto:<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Imagem-tabela.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\" size-medium wp-image-2515 aligncenter\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Imagem-tabela.png\" alt=\"Imagem tabela\" width=\"300\" height=\"158\" \/><\/a><\/p>\n<p><strong><span style=\"text-decoration: underline;\">1. CONDI\u00c7\u00d5ES PR\u00c9-MALIGNAS DO EST\u00d4MAGO<\/span><\/strong><\/p>\n<ul>\n<li><strong>P\u00f3lipos g\u00e1stricos epiteliais espor\u00e1dicos<\/strong><\/li>\n<\/ul>\n<p>A maioria (70% &#8211; 90%) s\u00e3o p\u00f3lipos de gl\u00e2ndulas f\u00fandicas (PGFs) ou p\u00f3lipos hiperpl\u00e1sicos.<\/p>\n<p>PGFs podem surgir em associa\u00e7\u00e3o ao uso cr\u00f4nico de IBPs, e n\u00e3o est\u00e3o relacionados com maligniza\u00e7\u00e3o.<\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/assuntos-gerais-polipos-hiperplasicos-de-estomago\">P\u00f3lipos hiperpl\u00e1sicos<\/a>, por sua vez, est\u00e3o associados ao aumento de risco de c\u00e2ncer g\u00e1strico, j\u00e1 que elementos displ\u00e1sicos e neoplasia focal podem ser encontrados em 5%-19% destes.<\/p>\n<p>P\u00f3lipos adenomatosos possuem potencial maligno e devem ser removidos endoscopicamente. Durante seguimento, a recorr\u00eancia ap\u00f3s ressec\u00e7\u00e3o tem sido reportada em torno de 2.6%, e a presen\u00e7a de neoplasia g\u00e1strica em 1.3%. Recomenda-se endoscopia de controle 1 ano ap\u00f3s ressec\u00e7\u00e3o de p\u00f3lipo adenomatoso, com posterior seguimento endosc\u00f3pico a cada 3-5 anos.<\/p>\n<p><span style=\"text-decoration: underline;\">RECOMENDA\u00c7\u00d5ES:<\/span><\/p>\n<ul>\n<li>Bi\u00f3psia, ou ressec\u00e7\u00e3o quando poss\u00edvel, de p\u00f3lipos g\u00e1stricos solit\u00e1rios <strong>(4+)<\/strong><\/li>\n<li>Polipectomia de PGF \u2265 1 cm, p\u00f3lipo hiperpl\u00e1sico \u22650,5 cm, e p\u00f3lipo adenomatoso de qualquer tamanho, quando poss\u00edvel <strong>(2+)<\/strong><\/li>\n<li>Vigil\u00e2ncia endosc\u00f3pica 1 ano ap\u00f3s a remo\u00e7\u00e3o de p\u00f3lipos adenomatosos <strong>(2+)<\/strong><\/li>\n<li>Na presen\u00e7a de m\u00faltiplos p\u00f3lipos recomenda-se ressec\u00e7\u00e3o dos maiores e bi\u00f3psias para amostragem dos demais <strong>(4+)<\/strong><\/li>\n<li>Na presen\u00e7a de m\u00faltiplos p\u00f3lipos hiperpl\u00e1sicos ou adenomatosos, sugere-se bi\u00f3psias da mucosa g\u00e1strica ao redor dos p\u00f3lipos para avaliar a presen\u00e7a de <em> pylori<\/em> e gastrite atr\u00f3fica metapl\u00e1sica <strong>(2+)<\/strong><\/li>\n<\/ul>\n<ul>\n<li><strong>P\u00f3lipos g\u00e1stricos em paciente com polipose adenomatosa familiar (PAF) e S\u00edndrome de Lynch (SL)<\/strong><\/li>\n<\/ul>\n<p>P\u00f3lipos g\u00e1stricos s\u00e3o comuns em pacientes com PAF. Os PGFs s\u00e3o os mais frequentes, sendo encontrados em mais de 88% das crian\u00e7as e adultos com PAF. Casos de adenocarcinoma g\u00e1strico associado aos PGFs t\u00eam sido descrito nesses pacientes.<\/p>\n<p>Adenoma g\u00e1strico tamb\u00e9m ocorre em pacientes com PAF, e quando presente\u00a0 geralmente \u00e9 solit\u00e1rio, s\u00e9ssil e localizado no antro.<\/p>\n<p>At\u00e9 o momento, existem dados conflitantes na literatura acerca do risco de desenvolvimento de\u00a0c\u00e2ncer g\u00e1strico em pacientes com SL.<\/p>\n<p><span style=\"text-decoration: underline;\">RECOMENDA\u00c7\u00d5ES:<\/span><\/p>\n<ul>\n<li>Bi\u00f3psias e, quando vi\u00e1vel, ressec\u00e7\u00e3o dos p\u00f3lipos g\u00e1stricos maiores em pacientes com FAP, para confirmar histologia e avaliar displasia <strong>(2+)<\/strong><\/li>\n<\/ul>\n<ul>\n<li><strong>Metaplasia g\u00e1strica intestinal e displasia<\/strong><\/li>\n<\/ul>\n<p>Metaplasia g\u00e1strica intestinal (MGI) \u00e9 uma condi\u00e7\u00e3o pr\u00e9-maligna, com incid\u00eancia de c\u00e2ncer no acompanhamento em torno de 11%, podendo chegar at\u00e9 85% em pacientes com displasia de alto grau (DAG).<\/p>\n<p>Vigil\u00e2ncia endosc\u00f3pica sugerida conforme recente <a href=\"http:\/\/www.esge.com\/assets\/downloads\/pdfs\/guidelines\/2012_maps.pdf\" target=\"_blank\" rel=\"noopener\">consenso Europeu<\/a>:<\/p>\n<p>&#8211; MGI com displasia de baixo grau (DBG) = repetir EDA em 1 ano com bi\u00f3psias (o tempo ideal de seguimento subsequente \u00e9 desconhecido).<\/p>\n<p>&#8211; Vigil\u00e2ncia pode ser suspensa na presen\u00e7a de duas EDAs consecutivas sem displasia.<\/p>\n<p>&#8211; MGI com displasia de alto grau (DAG) = ressec\u00e7\u00e3o endosc\u00f3pica ou cir\u00fargica, devido \u00e0 alta probabilidade de adenocarcinoma invasivo.<\/p>\n<p>&#8211; Pesquisa do <em>H. pylori<\/em> e erradica\u00e7\u00e3o quando presente<\/p>\n<p><span style=\"text-decoration: underline;\">RECOMENDA\u00c7\u00d5ES:<\/span><\/p>\n<ul>\n<li>Na popula\u00e7\u00e3o americana, acredita-se que o risco de progress\u00e3o para c\u00e2ncer seja baixo, dessa forma a vigil\u00e2ncia endosc\u00f3pica para pacientes com MGI deve ser feita em pacientes com risco elevado, dado por antecedentes \u00e9tnicos e familiares. O intervalo de vigil\u00e2ncia ainda n\u00e3o \u00e9 bem estabelecido, e deve ser individualizado. <strong>(2+)<\/strong><\/li>\n<li>Ressec\u00e7\u00e3o e vigil\u00e2ncia endosc\u00f3pica em pacientes com MGI e DAG <strong>(3+).<\/strong><\/li>\n<\/ul>\n<ul>\n<li><strong>Anemia perniciosa<\/strong><\/li>\n<\/ul>\n<p>A preval\u00eancia de adenocarcinoma g\u00e1strico em pacientes com anemia perniciosa (gastrite atr\u00f3fica tipo A) \u00e9 de 1% a 3%, sendo mais elevado o risco de desenvolver c\u00e2ncer dentro do primeiro ano ap\u00f3s o diagn\u00f3stico.<\/p>\n<p>Tumores neuroend\u00f3crinos\u00a0g\u00e1stricos tamb\u00e9m foram observados\u00a0em estudos prospectivos em pacientes submetidos \u00e0 vigil\u00e2ncia endosc\u00f3pica.<\/p>\n<p>Os benef\u00edcios de uma vigil\u00e2ncia endosc\u00f3pica ainda n\u00e3o est\u00e3o bem estabelecidos.<\/p>\n<p><span style=\"text-decoration: underline;\">RECOMENDA\u00c7\u00d5ES:<\/span><\/p>\n<ul>\n<li>EDA dentro de 6 meses ap\u00f3s o diagn\u00f3stico de anemia perniciosa e naqueles pacientes com presen\u00e7a de sintomas digestivos\u00a0altos <strong>(2+).<\/strong><\/li>\n<\/ul>\n<ul>\n<li><strong>Tumor neuroend\u00f3crino\u00a0g\u00e1strico<\/strong><\/li>\n<\/ul>\n<p>Clique <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/tratamento-de-tumor-neuroendocrino-gastrico\/\" target=\"_blank\" rel=\"noopener\">aqui<\/a> para informa\u00e7\u00f5es detalhadas sobre o tema.<\/p>\n<ul>\n<li><strong>P\u00f3s operat\u00f3rio de gastrectomia parcial \u2013 por \u00falcera\u00a0p\u00e9ptica<\/strong><\/li>\n<\/ul>\n<p>Existem dados conflitantes na literatura sobre o aumento do risco de neoplasia g\u00e1strica nesses pacientes. Estudos que demonstraram risco aumentado sugerem que o mesmo ocorre somente 15 a 20 anos ap\u00f3s a cirurgia.<\/p>\n<p><strong><span style=\"text-decoration: underline;\">2. CONDI\u00c7\u00d5ES MALIGNAS DO EST\u00d4MAGO<\/span><\/strong><\/p>\n<ul>\n<li><strong>\u00a0<\/strong><strong>Adenocarcinoma<\/strong><\/li>\n<\/ul>\n<p>\u00c9 a les\u00e3o g\u00e1strica maligna mais comum, podendo se apresentar como les\u00e3o vegetante, \u00falcera g\u00e1strica n\u00e3o cicatrizada, ou na forma infiltrativa difusa conhecida como linite pl\u00e1stica.<\/p>\n<p>EUS, com ou sem pun\u00e7\u00e3o por agulha fina (PAF), tem papel importante no estadiamento locorregional (T e N).<\/p>\n<p>Pacientes com c\u00e2ncer g\u00e1strico precoce (limitado \u00e0 mucosa e submucosa &#8211; est\u00e1gio T1), podem ser candidatos \u00e0 ressec\u00e7\u00e3o endosc\u00f3pica da les\u00e3o, realizada pela t\u00e9cnica de mucosectomia (EMR) ou dissec\u00e7\u00e3o submucosa (ESD).<\/p>\n<p>Uma metan\u00e1lise comparando EMR com ESD mostrou superioridade do ESD em rela\u00e7\u00e3o \u00e0 ressec\u00e7\u00e3o em bloco, ressec\u00e7\u00e3o completa, ressec\u00e7\u00e3o curativa e recorr\u00eancia local. Eventos adversos foram maiores no grupo ESD, incluindo sangramento intraoperat\u00f3rio e perfura\u00e7\u00e3o. A\u00a0mortalidade foi semelhantes entre os grupos.<\/p>\n<p><span style=\"text-decoration: underline;\">RECOMENDA\u00c7\u00d5ES:<\/span><\/p>\n<ul>\n<li>Pelo menos 7 bi\u00f3psias das les\u00f5es suspeitas de adenocarcinoma g\u00e1strico <strong>(4+).<\/strong><\/li>\n<li>Uso do EUS, com ou sem PAF, para estadiamento locorregional de c\u00e2ncer g\u00e1strico <strong>(2+).<\/strong><\/li>\n<li>Tratamento endosc\u00f3pico com pr\u00f3teses met\u00e1licas auto expans\u00edveis para palia\u00e7\u00e3o de c\u00e2ncer g\u00e1strico obstrutivo <strong>(3+).<\/strong><\/li>\n<\/ul>\n<ul>\n<li><strong>Linfoma MALT g\u00e1strico<\/strong><\/li>\n<\/ul>\n<p>Achados endosc\u00f3picos variam desde eros\u00f5es sutis a grandes massas.<\/p>\n<p>A infec\u00e7\u00e3o pelo <em>H. pylori<\/em> (HP) est\u00e1 presente em quase todos os casos, sendo sua erradica\u00e7\u00e3o o tratamento de escolha em pacientes com linfoma de baixo grau, com efic\u00e1cia na remiss\u00e3o cl\u00ednica acima de 80%.<\/p>\n<p>O intervalo ideal de vigil\u00e2ncia endosc\u00f3pica n\u00e3o est\u00e1 bem definido, por\u00e9m importante estudo mostrou baixos \u00edndices de progress\u00e3o com endoscopia com bi\u00f3psias a cada 3 a 6 meses por 2 anos ap\u00f3s a erradica\u00e7\u00e3o do HP, e posterior intervalo a cada 6 a 12 meses, em um seguimento de mais de 42 meses.<\/p>\n<p>EUS pode ser utilizado para defini\u00e7\u00e3o progn\u00f3stica, permitindo avalia\u00e7\u00e3o da profundidade de invas\u00e3o, bem como da presen\u00e7a de acometimento linfonodal.<\/p>\n<ul>\n<li><strong>Tumor estromal gastrointestinal (GIST)<\/strong><\/li>\n<\/ul>\n<p>GIST \u00e9 o tumor mesenquimal mais comum do est\u00f4mago e caracteriza-se por ser\u00a0uma les\u00e3o subepitelial.<\/p>\n<p>Achados no EUS preditores de malignidade s\u00e3o:<\/p>\n<p>&#8211; Tamanho &gt; 2cm<\/p>\n<p>&#8211; Bordas irregulares<\/p>\n<p>&#8211; Heterogeneidade<\/p>\n<p>&#8211; Invas\u00e3o de estruturas adjacentes<\/p>\n<p>A an\u00e1lise anatomopatol\u00f3gica do material obtido por PAF ecoguiada mostra c\u00e9lulas fusiformes, e a imunohistoqu\u00edmica evidencia\u00a0positividade para marcadores espec\u00edficos, como o CD117 (KIT).<\/p>\n<p>Deve-se considerar ressec\u00e7\u00e3o cir\u00fargica nos casos de: les\u00f5es sintom\u00e1ticas, maiores que 2 cm, e\/ou com altera\u00e7\u00f5es ao EUS sugestivas de potencial maligno.<\/p>\n<p><span style=\"text-decoration: underline;\">RECOMENDA\u00c7\u00d5ES:<\/span><\/p>\n<ul>\n<li>EUS, com ou sem PAF, para avalia\u00e7\u00e3o de les\u00f5es subepiteliais g\u00e1stricas <strong>(4+).<\/strong><\/li>\n<li>Vigil\u00e2ncia com EUS anual em GIST g\u00e1strico menor que 2 cm, caso n\u00e3o se opte por ressec\u00e7\u00e3o cir\u00fargica, para avaliar aumento progressivo ou mudan\u00e7as das caracter\u00edsticas ecogr\u00e1ficas <strong>(2+).<\/strong><\/li>\n<\/ul>\n<h3><a href=\"https:\/\/gastropedia.com.br\/cirurgia\/esofago-estomago-duodeno\/particao-gastrica-para-tratamento-de-tumores-gastricos-distais-obstrutivos-nao-ressecaveis\/\">Para saber mais sobre este tema, acesse o site Gastropedia clicando aqui!<\/a><\/h3>\n<p><strong>Refer\u00eancia:<\/strong><\/p>\n<p><a href=\"http:\/\/www.asge.org\/uploadedFiles\/Publications_(public)\/Practice_guidelines\/Endoscopy_premalignant_malignant_conditions.pdf\" target=\"_blank\" rel=\"noopener\">ASGE Standards of Practice Committee, Evans JA, Chandrasekhara V, Chathadi KV, et al.\u00a0The role of endoscopy in the management of premalignant and malignant conditions of thestomach.\u00a0Gastrointest Endosc. 2015 Jul;82(1):1-8.<\/a><\/p>\n<p><strong>Assuntos relacionados:<\/strong><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/linfoma-malt\/\" target=\"_blank\" rel=\"noopener\">Imagens &#8211; Linfoma MALT<\/a><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/neoplasia-gastrica-precoce\/\" target=\"_blank\" rel=\"noopener\">Imagens &#8211; Neoplasia g\u00e1strica precoce<\/a><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/metaplasia-gastrica\/\" target=\"_blank\" rel=\"noopener\">Imagens &#8211; Metaplasia g\u00e1strica<\/a><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/tratamento-de-tumor-neuroendocrino-gastrico\/\" target=\"_blank\" rel=\"noopener\">Assuntos gerais &#8211; Tratamento de tumor neuroend\u00f3crino g\u00e1strico<\/a><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/tumor-neuroendocrino-gastrico\/\" target=\"_blank\" rel=\"noopener\">Assuntos gerais &#8211; Tumor neuroend\u00f3crino g\u00e1strico<\/a><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/caso-clinico-linfoma-malt-gastrico-nao-associado-a-infeccao-pelo-helicobacter-pylori\/\" target=\"_blank\" rel=\"noopener\">Caso Cl\u00ednico \u2013 Linfoma MALT g\u00e1strico n\u00e3o associado a infec\u00e7\u00e3o pelo Helicobacter Pylori<\/a><\/p>\n<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/quiz-como-voce-descreveria-esta-lesao-gastrica-2\/\" target=\"_blank\" rel=\"noopener\">Quiz! \u2013 Como voc\u00ea descreveria esta les\u00e3o g\u00e1strica?<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Post realizado por: \u00a0Alex Baia Gualter Leite Resid\u00eancia de Gastroenterologia e Endoscopia Digestiva pela&hellip;<\/p>\n","protected":false},"author":5709,"featured_media":5020,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[282],"tipo":[153],"volume":[147],"class_list":["post-4269","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-282","tipo-endoscopia-digestiva-alta","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago\" \/>\n<meta property=\"og:description\" content=\"Post realizado por: \u00a0Alex Baia Gualter Leite Resid\u00eancia de Gastroenterologia e Endoscopia Digestiva pela Escola Paulista de Medicina \/ UNIFESP.\u00a0M\u00e9dico\" \/>\n<meta property=\"og:url\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/\" \/>\n<meta property=\"og:site_name\" content=\"Endoscopia Terapeutica\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endoscopiaterapeutica\" \/>\n<meta property=\"article:published_time\" content=\"2015-08-19T10:00:19+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-08-07T20:47:28+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Post-Alex-1024x672.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1024\" \/>\n\t<meta property=\"og:image:height\" content=\"672\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/\"},\"author\":{\"name\":\"Admin\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#\\\/schema\\\/person\\\/9c9bff19a8d5c478ef1f7279392a5d91\"},\"headline\":\"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago\",\"datePublished\":\"2015-08-19T10:00:19+00:00\",\"dateModified\":\"2023-08-07T20:47:28+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/\"},\"wordCount\":1397,\"commentCount\":8,\"publisher\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/wp-content\\\/uploads\\\/2015\\\/08\\\/Post-Alex.png\",\"articleSection\":[\"Assuntos Gerais\"],\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/\",\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/\",\"name\":\"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago &#8226; Endoscopia Terapeutica\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/wp-content\\\/uploads\\\/2015\\\/08\\\/Post-Alex.png\",\"datePublished\":\"2015-08-19T10:00:19+00:00\",\"dateModified\":\"2023-08-07T20:47:28+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#breadcrumb\"},\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#primaryimage\",\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/wp-content\\\/uploads\\\/2015\\\/08\\\/Post-Alex.png\",\"contentUrl\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/wp-content\\\/uploads\\\/2015\\\/08\\\/Post-Alex.png\",\"width\":1463,\"height\":960},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/assuntosgerais\\\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#website\",\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/\",\"name\":\"Endoscopia Terapeutica\",\"description\":\"O Jornal Endoscopia Terap\u00eautica tem como objetivo compartilhar experi\u00eancias da pr\u00e1tica di\u00e1ria, al\u00e9m de prover atualiza\u00e7\u00f5es e discuss\u00f5es sobre endoscopia digestiva.\",\"publisher\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"pt-BR\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#organization\",\"name\":\"Endoscopia Terapeutica\",\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/wp-content\\\/uploads\\\/2023\\\/09\\\/endter.jpg\",\"contentUrl\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/wp-content\\\/uploads\\\/2023\\\/09\\\/endter.jpg\",\"width\":720,\"height\":721,\"caption\":\"Endoscopia Terapeutica\"},\"image\":{\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/endoscopiaterapeutica\",\"https:\\\/\\\/www.instagram.com\\\/endoscopy\\\/\",\"https:\\\/\\\/www.youtube.com\\\/@endoscopyonline\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/#\\\/schema\\\/person\\\/9c9bff19a8d5c478ef1f7279392a5d91\",\"name\":\"Admin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"pt-BR\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/0ce0774c08ae411d8239080c7205c7f2455e4919166dde3873dcf33f29d61af7?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/0ce0774c08ae411d8239080c7205c7f2455e4919166dde3873dcf33f29d61af7?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/0ce0774c08ae411d8239080c7205c7f2455e4919166dde3873dcf33f29d61af7?s=96&d=mm&r=g\",\"caption\":\"Admin\"},\"url\":\"https:\\\/\\\/endoscopiaterapeutica.net\\\/pt\\\/author\\\/ingastro\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago &#8226; Endoscopia Terapeutica","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/","og_locale":"pt_BR","og_type":"article","og_title":"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago","og_description":"Post realizado por: \u00a0Alex Baia Gualter Leite Resid\u00eancia de Gastroenterologia e Endoscopia Digestiva pela Escola Paulista de Medicina \/ UNIFESP.\u00a0M\u00e9dico","og_url":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/","og_site_name":"Endoscopia Terapeutica","article_publisher":"https:\/\/www.facebook.com\/endoscopiaterapeutica","article_published_time":"2015-08-19T10:00:19+00:00","article_modified_time":"2023-08-07T20:47:28+00:00","og_image":[{"width":1024,"height":672,"url":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Post-Alex-1024x672.png","type":"image\/png"}],"author":"Admin","twitter_card":"summary_large_image","twitter_misc":{"Escrito por":"Admin","Est. tempo de leitura":"7 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#article","isPartOf":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/"},"author":{"name":"Admin","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#\/schema\/person\/9c9bff19a8d5c478ef1f7279392a5d91"},"headline":"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago","datePublished":"2015-08-19T10:00:19+00:00","dateModified":"2023-08-07T20:47:28+00:00","mainEntityOfPage":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/"},"wordCount":1397,"commentCount":8,"publisher":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#organization"},"image":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#primaryimage"},"thumbnailUrl":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Post-Alex.png","articleSection":["Assuntos Gerais"],"inLanguage":"pt-BR","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/","url":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/","name":"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago &#8226; Endoscopia Terapeutica","isPartOf":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#website"},"primaryImageOfPage":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#primaryimage"},"image":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#primaryimage"},"thumbnailUrl":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Post-Alex.png","datePublished":"2015-08-19T10:00:19+00:00","dateModified":"2023-08-07T20:47:28+00:00","breadcrumb":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#breadcrumb"},"inLanguage":"pt-BR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/"]}]},{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#primaryimage","url":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Post-Alex.png","contentUrl":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2015\/08\/Post-Alex.png","width":1463,"height":960},{"@type":"BreadcrumbList","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/o-papel-da-endoscopia-no-manejo-de-lesao-pre-malignas-e-malignas-do-estomago\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/endoscopiaterapeutica.net\/pt\/"},{"@type":"ListItem","position":2,"name":"O papel da endoscopia no manejo das les\u00f5es pr\u00e9-malignas e malignas do est\u00f4mago"}]},{"@type":"WebSite","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#website","url":"https:\/\/endoscopiaterapeutica.net\/pt\/","name":"Endoscopia Terapeutica","description":"O Jornal Endoscopia Terap\u00eautica tem como objetivo compartilhar experi\u00eancias da pr\u00e1tica di\u00e1ria, al\u00e9m de prover atualiza\u00e7\u00f5es e discuss\u00f5es sobre endoscopia digestiva.","publisher":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/endoscopiaterapeutica.net\/pt\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"pt-BR"},{"@type":"Organization","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#organization","name":"Endoscopia Terapeutica","url":"https:\/\/endoscopiaterapeutica.net\/pt\/","logo":{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#\/schema\/logo\/image\/","url":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/09\/endter.jpg","contentUrl":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2023\/09\/endter.jpg","width":720,"height":721,"caption":"Endoscopia Terapeutica"},"image":{"@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/endoscopiaterapeutica","https:\/\/www.instagram.com\/endoscopy\/","https:\/\/www.youtube.com\/@endoscopyonline"]},{"@type":"Person","@id":"https:\/\/endoscopiaterapeutica.net\/pt\/#\/schema\/person\/9c9bff19a8d5c478ef1f7279392a5d91","name":"Admin","image":{"@type":"ImageObject","inLanguage":"pt-BR","@id":"https:\/\/secure.gravatar.com\/avatar\/0ce0774c08ae411d8239080c7205c7f2455e4919166dde3873dcf33f29d61af7?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/0ce0774c08ae411d8239080c7205c7f2455e4919166dde3873dcf33f29d61af7?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/0ce0774c08ae411d8239080c7205c7f2455e4919166dde3873dcf33f29d61af7?s=96&d=mm&r=g","caption":"Admin"},"url":"https:\/\/endoscopiaterapeutica.net\/pt\/author\/ingastro\/"}]}},"_links":{"self":[{"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/posts\/4269","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/users\/5709"}],"replies":[{"embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/comments?post=4269"}],"version-history":[{"count":4,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/posts\/4269\/revisions"}],"predecessor-version":[{"id":16900,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/posts\/4269\/revisions\/16900"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/media\/5020"}],"wp:attachment":[{"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/media?parent=4269"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/categories?post=4269"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/tags?post=4269"},{"taxonomy":"ano","embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/ano?post=4269"},{"taxonomy":"tipo","embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/tipo?post=4269"},{"taxonomy":"volume","embeddable":true,"href":"https:\/\/endoscopiaterapeutica.net\/pt\/wp-json\/wp\/v2\/volume?post=4269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}