[
  {
    "start": 0.0,
    "end": 3.68,
    "text": " Hello, everyone. Welcome to this episode of the USU Talks."
  },
  {
    "start": 3.68,
    "end": 7.76,
    "text": " It's Pradeepundra here, and I'm your host for today."
  },
  {
    "start": 7.76,
    "end": 11.72,
    "text": " This is the second part of our podcast on MAPS,"
  },
  {
    "start": 11.72,
    "end": 16.4,
    "text": " three guidelines with Professor Mario Denis Ribeiro,"
  },
  {
    "start": 16.4,
    "end": 20.8,
    "text": " full professor of the Faculty of Medicine at the University of Porto,"
  },
  {
    "start": 20.8,
    "end": 23.6,
    "text": " consultant gastroenterologist and head of"
  },
  {
    "start": 23.6,
    "end": 27.0,
    "text": " Porto Comprehensive Cancer Centre and"
  },
  {
    "start": 27.0,
    "end": 30.68,
    "text": " vice-director of the research centre there."
  },
  {
    "start": 30.68,
    "end": 34.76,
    "text": " If you haven't listened to the first part of this episode, I urge you to do so"
  },
  {
    "start": 34.76,
    "end": 38.76,
    "text": " before listening to this. This is the second part of the two-part"
  },
  {
    "start": 38.76,
    "end": 42.76,
    "text": " series. So in the first part we discussed"
  },
  {
    "start": 42.76,
    "end": 48.2,
    "text": " the scope of the MAPS three guidelines. We discussed screening for gastric"
  },
  {
    "start": 48.2,
    "end": 52.04,
    "text": " cancer and pre-malignant lesions. We also discussed"
  },
  {
    "start": 52.04,
    "end": 55.96,
    "text": " population-based screening and how to become"
  },
  {
    "start": 55.96,
    "end": 61.0,
    "text": " better in recognising and describing pre-malignant lesions"
  },
  {
    "start": 61.0,
    "end": 65.88,
    "text": " in that episode. So let's continue that in this second part."
  },
  {
    "start": 65.88,
    "end": 70.68,
    "text": " Here to come. Mario, coming on to the next statement or the other"
  },
  {
    "start": 70.68,
    "end": 74.92,
    "text": " statements that come through, you made a statement on use of AI-assisted"
  },
  {
    "start": 74.92,
    "end": 77.88,
    "text": " detection. Now, I have covered this in one of the"
  },
  {
    "start": 77.88,
    "end": 81.72,
    "text": " other podcasts, a use of AI in the upper G.I. track with Alana"
  },
  {
    "start": 81.72,
    "end": 85.88,
    "text": " Hebicbeau. That's a much longer one. We discussed all aspects, but what was the"
  },
  {
    "start": 85.88,
    "end": 90.44,
    "text": " guideline committee recommendation on use of artificial intelligence"
  },
  {
    "start": 90.44,
    "end": 95.24,
    "text": " in the upper G.I. track as of now? I'm sure this is an evolving field"
  },
  {
    "start": 95.24,
    "end": 99.96,
    "text": " and things will change in the future. So first of all, we had the chance to"
  },
  {
    "start": 99.96,
    "end": 104.2,
    "text": " systemically review the literature a couple of years ago and what we've"
  },
  {
    "start": 104.2,
    "end": 108.2,
    "text": " shown was that most of the systems reached the expert level"
  },
  {
    "start": 108.2,
    "end": 112.6,
    "text": " defined as the chance of not missing more than 10 percent. And I think"
  },
  {
    "start": 112.6,
    "end": 116.92,
    "text": " this is a scary feature or number that was"
  },
  {
    "start": 116.92,
    "end": 121.24,
    "text": " consistently suggested that we may miss 10 percent of lesions seen"
  },
  {
    "start": 121.24,
    "end": 125.48,
    "text": " in the stomach. And based on this, AI was kind of"
  },
  {
    "start": 125.48,
    "end": 128.6,
    "text": " levelled to this level. And for detection,"
  },
  {
    "start": 128.6,
    "end": 133.88,
    "text": " ESG recommended that the system should have 90 percent of detection"
  },
  {
    "start": 133.88,
    "end": 138.52,
    "text": " rate or above. For characterization, we could accept"
  },
  {
    "start": 138.52,
    "end": 142.52,
    "text": " a lower threshold of 80 percent again, as experts are able to"
  },
  {
    "start": 142.52,
    "end": 145.56,
    "text": " anticipate curative resection for when they see"
  },
  {
    "start": 145.56,
    "end": 149.16,
    "text": " superficial lesions, and the same 90 percent for detecting"
  },
  {
    "start": 149.16,
    "end": 153.08,
    "text": " premalignant conditions. So this threshold is, well, we can compare"
  },
  {
    "start": 153.08,
    "end": 157.24,
    "text": " this with other metrics that we have in other parts of the globe"
  },
  {
    "start": 157.24,
    "end": 161.64,
    "text": " for the use of virtual commandoscopy, etc. But for instance,"
  },
  {
    "start": 161.64,
    "end": 166.2,
    "text": " are these levels of accuracy that eventually providers"
  },
  {
    "start": 166.2,
    "end": 171.8,
    "text": " of AI, are we there? The studies, they say yes, but then, for instance, when we"
  },
  {
    "start": 171.8,
    "end": 177.0,
    "text": " go for cost-effectiveness to try to see if AI could bring"
  },
  {
    "start": 177.0,
    "end": 181.32,
    "text": " to a different level the performance of bestoscopy in different countries,"
  },
  {
    "start": 181.32,
    "end": 185.88,
    "text": " we would require a higher level of accuracy from the systems"
  },
  {
    "start": 185.88,
    "end": 190.44,
    "text": " at the low cost. For instance, for Netherlands and for Italy, that those"
  },
  {
    "start": 190.44,
    "end": 194.28,
    "text": " were the countries that we used as contrast to Portugal"
  },
  {
    "start": 194.28,
    "end": 198.36,
    "text": " to show if these systems could be cost-effective if they"
  },
  {
    "start": 198.36,
    "end": 204.28,
    "text": " would be applied to endoscopy. So answering briefly, what we said"
  },
  {
    "start": 204.28,
    "end": 208.52,
    "text": " is that if the systems that you may have in front of you are"
  },
  {
    "start": 208.52,
    "end": 212.68,
    "text": " already validated and have that threshold,"
  },
  {
    "start": 212.68,
    "end": 216.68,
    "text": " I think this will come to our practice. We don't want to miss a class, so when"
  },
  {
    "start": 216.68,
    "end": 220.6,
    "text": " we do an astroscopy, and we would like to have systems that"
  },
  {
    "start": 220.6,
    "end": 225.72,
    "text": " eventually automatically would stage the strategies that is in front of you, and"
  },
  {
    "start": 225.72,
    "end": 228.76,
    "text": " we'll say even okay, you need to survey all these patients."
  },
  {
    "start": 228.76,
    "end": 234.84,
    "text": " Yeah, just for clarity, Mario, when you refer to AI detection,"
  },
  {
    "start": 234.84,
    "end": 238.2,
    "text": " meeting expert standards, is that detection of"
  },
  {
    "start": 238.2,
    "end": 242.76,
    "text": " pre-elegant lesions or is that detection of dysplasia and cancer?"
  },
  {
    "start": 242.76,
    "end": 247.88,
    "text": " Just want to clarify that. They are both. Yeah, both. So there are systems that are"
  },
  {
    "start": 247.88,
    "end": 251.4,
    "text": " more developed for detecting cancer."
  },
  {
    "start": 251.4,
    "end": 256.6,
    "text": " There are some studies, not that many, for detecting pre-elegant."
  },
  {
    "start": 256.6,
    "end": 259.96,
    "text": " And even in our group, we have been"
  },
  {
    "start": 259.96,
    "end": 264.2,
    "text": " presenting that recently, where we were able to develop some algorithms"
  },
  {
    "start": 264.2,
    "end": 268.36,
    "text": " that can establish as good as experts"
  },
  {
    "start": 268.36,
    "end": 272.44,
    "text": " the staging of intestinal manipulation. So we will be there,"
  },
  {
    "start": 272.44,
    "end": 275.88,
    "text": " not now, but we will be there. Yeah. Mario, I just wanted to cover a couple of"
  },
  {
    "start": 275.88,
    "end": 279.08,
    "text": " points from the astrodraws who routinely deal with"
  },
  {
    "start": 279.08,
    "end": 281.96,
    "text": " management of dysplasia and early cancer."
  },
  {
    "start": 281.96,
    "end": 286.2,
    "text": " There's a couple of things I think they would benefit from discussing."
  },
  {
    "start": 286.2,
    "end": 289.88,
    "text": " Let's say patients have early gastric cancer,"
  },
  {
    "start": 289.88,
    "end": 294.52,
    "text": " which is resectible endoscopically. The routine practice"
  },
  {
    "start": 294.52,
    "end": 298.04,
    "text": " in our centre is anything that's called a cancer we do"
  },
  {
    "start": 298.04,
    "end": 301.72,
    "text": " as staging CT scan. But the guideline committee seems to deviate"
  },
  {
    "start": 301.72,
    "end": 306.04,
    "text": " slightly from that. I think if you just say a couple of lines about it,"
  },
  {
    "start": 306.04,
    "end": 310.68,
    "text": " because that's, I think, is a bit practice changing and potentially"
  },
  {
    "start": 310.68,
    "end": 315.24,
    "text": " will save a lot of resources. And I remember for my days when I was in"
  },
  {
    "start": 315.24,
    "end": 319.64,
    "text": " Japan, they didn't do CT scans there. So we seem to"
  },
  {
    "start": 319.64,
    "end": 322.68,
    "text": " differ in the West. Can you just say a couple of lines for"
  },
  {
    "start": 322.68,
    "end": 325.72,
    "text": " the benefit of gastric doctors who deal with these things?"
  },
  {
    "start": 325.72,
    "end": 329.48,
    "text": " Yeah, definitely. So what we suggested was that,"
  },
  {
    "start": 329.48,
    "end": 333.08,
    "text": " of course, this is applicable to all the things that you do."
  },
  {
    "start": 333.08,
    "end": 336.44,
    "text": " You should have a high quality endoscopy and you need to be sure that that"
  },
  {
    "start": 336.44,
    "end": 340.04,
    "text": " lesion that is in front of you, you adequately"
  },
  {
    "start": 340.04,
    "end": 345.0,
    "text": " characterized and eventually it's enough to have been the scoping"
  },
  {
    "start": 345.0,
    "end": 349.08,
    "text": " fixture. So if you use the location, the size,"
  },
  {
    "start": 349.08,
    "end": 353.4,
    "text": " the Paris classification and in the absence of any signs"
  },
  {
    "start": 353.4,
    "end": 359.08,
    "text": " of deep submacosal invasion, CT scan in the US does not have"
  },
  {
    "start": 359.08,
    "end": 363.16,
    "text": " to be making any decisions. So of course, if the patient is comfortable"
  },
  {
    "start": 363.16,
    "end": 365.96,
    "text": " with that, you should resect the lesion and"
  },
  {
    "start": 365.96,
    "end": 369.96,
    "text": " decide afterwards. Of course, we know that we miss"
  },
  {
    "start": 369.96,
    "end": 376.6,
    "text": " 20% of lesions that we may, let's say, so it's a 20%"
  },
  {
    "start": 376.6,
    "end": 380.84,
    "text": " misdiagnosis when we allocate patients to treatment. But on the other side, we do"
  },
  {
    "start": 380.84,
    "end": 384.68,
    "text": " know that from these, some of them will not have surgical conditions."
  },
  {
    "start": 384.68,
    "end": 390.84,
    "text": " So they were treated anyhow and some of the others will have been missed by US"
  },
  {
    "start": 390.84,
    "end": 395.48,
    "text": " because we do know that also a misdiagnosis occurs or misstaging occurs"
  },
  {
    "start": 395.48,
    "end": 399.8,
    "text": " when even among the best US performers. So in the"
  },
  {
    "start": 399.8,
    "end": 404.04,
    "text": " absence of signs of deep submacosal invasion, chances of having the muscle"
  },
  {
    "start": 404.04,
    "end": 407.48,
    "text": " appropriate also involved, there is no reason to"
  },
  {
    "start": 407.48,
    "end": 410.76,
    "text": " perform further staging. And this change, of course, after the"
  },
  {
    "start": 410.76,
    "end": 414.6,
    "text": " resection where you then you need to stage properly the patient to"
  },
  {
    "start": 414.6,
    "end": 418.76,
    "text": " manage if they finally not curative occurs. So in this setting,"
  },
  {
    "start": 418.76,
    "end": 422.2,
    "text": " the guidelines does not add too much to the most recent"
  },
  {
    "start": 422.2,
    "end": 425.8,
    "text": " guideline that was published before this. The effort here was just to"
  },
  {
    "start": 425.8,
    "end": 429.72,
    "text": " comprehensively bring this discussion towards this field."
  },
  {
    "start": 429.72,
    "end": 433.88,
    "text": " So no major changes the readers may expect to see"
  },
  {
    "start": 433.88,
    "end": 439.48,
    "text": " within the MAPS 3-3 guidelines. So from the curative resection criteria"
  },
  {
    "start": 439.48,
    "end": 442.52,
    "text": " compared to previous guidelines, you're keeping it"
  },
  {
    "start": 442.52,
    "end": 448.52,
    "text": " roughly similar. Yeah, what we did suggest, of course,"
  },
  {
    "start": 448.52,
    "end": 452.52,
    "text": " it's still, it will be very difficult, but again"
  },
  {
    "start": 452.52,
    "end": 456.44,
    "text": " coming back to your comments where we do too many endoscopies and I"
  },
  {
    "start": 456.44,
    "end": 460.04,
    "text": " completely agree, what we suggested is that"
  },
  {
    "start": 460.04,
    "end": 464.84,
    "text": " there may be some groups of patients where in the absence of further risk"
  },
  {
    "start": 464.84,
    "end": 468.92,
    "text": " factors for metachronous lesions, we could release them from surveillance"
  },
  {
    "start": 468.92,
    "end": 472.28,
    "text": " or at least to to do a less intensified"
  },
  {
    "start": 472.28,
    "end": 476.44,
    "text": " surveillance after the resection. So if there is some logic about what we are"
  },
  {
    "start": 476.44,
    "end": 481.0,
    "text": " suggesting, you will have more screened people once in a lifetime screened"
  },
  {
    "start": 481.0,
    "end": 484.6,
    "text": " individuals. Some of them will harbor superficial lesions"
  },
  {
    "start": 484.6,
    "end": 488.52,
    "text": " and most of them will survive. So we need probably to have also some"
  },
  {
    "start": 488.52,
    "end": 491.64,
    "text": " metrics and measures to overburden"
  },
  {
    "start": 491.64,
    "end": 495.32,
    "text": " survivors that will more and more come to our services."
  },
  {
    "start": 495.32,
    "end": 500.84,
    "text": " So I do expect that we endoscopies in this field of cancer, we will"
  },
  {
    "start": 500.84,
    "end": 506.28,
    "text": " transform the surveillance in a very, let's say, less invasive form of"
  },
  {
    "start": 506.28,
    "end": 510.44,
    "text": " caring of patients. I will not allude non-invasive markers because they"
  },
  {
    "start": 510.44,
    "end": 513.64,
    "text": " don't exist, but eventually that will come also."
  },
  {
    "start": 513.64,
    "end": 518.12,
    "text": " Okay, Maria, the next section of discussion, which is probably most"
  },
  {
    "start": 518.12,
    "end": 523.24,
    "text": " important, I want to focus on recognizing or"
  },
  {
    "start": 523.24,
    "end": 527.56,
    "text": " identifying pre-metachronous lesions, how to describe these things,"
  },
  {
    "start": 527.56,
    "end": 532.52,
    "text": " common mistakes that are made. I think this part is extremely important for"
  },
  {
    "start": 532.52,
    "end": 536.52,
    "text": " most endoscopies who don't routinely deal with"
  },
  {
    "start": 536.52,
    "end": 539.8,
    "text": " the gastric pre-metachronous lesions or deal with"
  },
  {
    "start": 539.8,
    "end": 544.76,
    "text": " resection of dysplastic lesions. Now let's start with a practical question."
  },
  {
    "start": 544.76,
    "end": 548.28,
    "text": " Let's say you talked about opportunistic screening. Let's say"
  },
  {
    "start": 548.28,
    "end": 552.44,
    "text": " patient comes in with dyspepsia and I'm doing an endoscopy"
  },
  {
    "start": 552.44,
    "end": 556.36,
    "text": " and I roughly know what atropia is, I know"
  },
  {
    "start": 556.36,
    "end": 559.96,
    "text": " what interstellar metoplasia is, and I start seeing this."
  },
  {
    "start": 559.96,
    "end": 564.92,
    "text": " How systematically, how do you approach in reporting this endoscopy"
  },
  {
    "start": 564.92,
    "end": 568.6,
    "text": " in terms of reporting this atropia in the interstellar metoplasia"
  },
  {
    "start": 568.6,
    "end": 573.0,
    "text": " and what's your systematic approach to its taking the biopsies? Just, you know,"
  },
  {
    "start": 573.0,
    "end": 576.76,
    "text": " give us a brief summary. I'm sure the listeners can go through the guidelines"
  },
  {
    "start": 576.76,
    "end": 581.08,
    "text": " it's well described there. So first of all, don't focus too much on"
  },
  {
    "start": 581.08,
    "end": 585.96,
    "text": " biopsies and consider that you are the best morphologist"
  },
  {
    "start": 585.96,
    "end": 590.6,
    "text": " at that moment. So clean the mucosa, insufflate this insufflate and"
  },
  {
    "start": 590.6,
    "end": 593.8,
    "text": " insufflate again so that you see that you are"
  },
  {
    "start": 593.8,
    "end": 597.72,
    "text": " sure that you didn't miss any cancer. Okay?"
  },
  {
    "start": 597.72,
    "end": 601.4,
    "text": " Afterwards, I always start by looking at the entrum"
  },
  {
    "start": 601.4,
    "end": 605.96,
    "text": " and the incisors quite carefully. This is the region where"
  },
  {
    "start": 605.96,
    "end": 611.32,
    "text": " Hpylori-related male plages occur more often and still in one systematic review"
  },
  {
    "start": 611.32,
    "end": 614.44,
    "text": " that we also published, one quarter of the missing"
  },
  {
    "start": 614.44,
    "end": 619.32,
    "text": " cancers are there. So if you nicely see that region and if you take"
  },
  {
    "start": 619.32,
    "end": 623.96,
    "text": " time, well most of the scope providers nowadays"
  },
  {
    "start": 623.96,
    "end": 627.16,
    "text": " they have systems of virtual chromandoscopy and you can either"
  },
  {
    "start": 627.16,
    "end": 630.6,
    "text": " start by white light and move to virtual chromandoscopy"
  },
  {
    "start": 630.6,
    "end": 635.24,
    "text": " and get back to white light back and forward. Then with that process you also"
  },
  {
    "start": 635.24,
    "end": 638.12,
    "text": " learn how to recognize these changes even with"
  },
  {
    "start": 638.12,
    "end": 642.04,
    "text": " flashlight. Then I moved upwards and do the same process."
  },
  {
    "start": 642.04,
    "end": 646.52,
    "text": " Looking at the entrum and incisora and the lesser curvature you can"
  },
  {
    "start": 646.52,
    "end": 652.04,
    "text": " recognize trophic changes by a pale mucosa that is whitish"
  },
  {
    "start": 652.04,
    "end": 658.12,
    "text": " and eventually with some line that separates these two compartments"
  },
  {
    "start": 658.12,
    "end": 661.72,
    "text": " differently from the anatomic compartment at this densivora. So if you"
  },
  {
    "start": 661.72,
    "end": 665.72,
    "text": " see that line in the entrum and in incisora probably this patient has"
  },
  {
    "start": 665.72,
    "end": 668.92,
    "text": " a trophic changes in the entrum, it may or may not"
  },
  {
    "start": 668.92,
    "end": 674.28,
    "text": " have a testamentoplasia and the same goes to the corpus that"
  },
  {
    "start": 674.28,
    "end": 678.52,
    "text": " that is less frequent and of course I will not allow now to"
  },
  {
    "start": 678.52,
    "end": 682.36,
    "text": " alter in monoconstritis that it's the other way around. You can anticipate"
  },
  {
    "start": 682.36,
    "end": 686.6,
    "text": " these changes most often in the corpus. When we touch the bottom to"
  },
  {
    "start": 686.6,
    "end": 690.84,
    "text": " use virtual chromandoscopy then you may see areas that you may recognize as"
  },
  {
    "start": 690.84,
    "end": 694.84,
    "text": " a testamentoplasia, bluish areas, some tubulus"
  },
  {
    "start": 694.84,
    "end": 698.92,
    "text": " villus pattern. You may see a light blue crest that is"
  },
  {
    "start": 698.92,
    "end": 703.24,
    "text": " a very very nice signal that once you see it you"
  },
  {
    "start": 703.24,
    "end": 708.76,
    "text": " never forget it and you may measure or anticipate the"
  },
  {
    "start": 708.76,
    "end": 713.16,
    "text": " extension of these changes. So in terms of report what I do is"
  },
  {
    "start": 713.16,
    "end": 719.56,
    "text": " I say I didn't see any superficial lesion in the fundus, in the corpus,"
  },
  {
    "start": 719.56,
    "end": 723.08,
    "text": " in incisora and in the entrum. I recognize"
  },
  {
    "start": 723.08,
    "end": 727.08,
    "text": " trophic changes by endoscopy only in the entrum,"
  },
  {
    "start": 727.08,
    "end": 731.4,
    "text": " in the entrum incisora or affecting the entire entrum and corpus"
  },
  {
    "start": 731.4,
    "end": 734.76,
    "text": " and I do recognize some changes of the testamentoplasia"
  },
  {
    "start": 734.76,
    "end": 738.6,
    "text": " again in the entrum incisora and or in the corpus."
  },
  {
    "start": 738.6,
    "end": 742.2,
    "text": " After that if I do recognize the testamentoplasia"
  },
  {
    "start": 742.2,
    "end": 746.44,
    "text": " I tend to target the biopsies to those areas"
  },
  {
    "start": 746.44,
    "end": 751.88,
    "text": " but we should always do two biopsies in the entrum in the lesser curvature"
  },
  {
    "start": 751.88,
    "end": 755.16,
    "text": " and the greater curvature and two in the corpus"
  },
  {
    "start": 755.16,
    "end": 759.48,
    "text": " and send these two pairs separately for pathologists."
  },
  {
    "start": 759.48,
    "end": 764.04,
    "text": " There is a lot of discussions if we need the biopsy from incisora,"
  },
  {
    "start": 764.04,
    "end": 768.04,
    "text": " there is a lot of discussion if we need to send separately these jars also to"
  },
  {
    "start": 768.04,
    "end": 771.0,
    "text": " save the environment to pathologists but at least"
  },
  {
    "start": 771.0,
    "end": 776.28,
    "text": " for now for most clinicians take care of the corpus, take care of the stomach"
  },
  {
    "start": 776.28,
    "end": 781.4,
    "text": " separately and report separately these morphological findings"
  },
  {
    "start": 781.4,
    "end": 784.68,
    "text": " and send separately the biopsies to the pathologists"
  },
  {
    "start": 784.68,
    "end": 789.32,
    "text": " at least in the very first endoscopy. During surveillance"
  },
  {
    "start": 789.32,
    "end": 792.84,
    "text": " with evidence that exists you may drop the need for biopsies"
  },
  {
    "start": 792.84,
    "end": 796.92,
    "text": " if you don't care again to screen for it's bilory so"
  },
  {
    "start": 796.92,
    "end": 800.2,
    "text": " if you screen a patient when it's 50 and you"
  },
  {
    "start": 800.2,
    "end": 804.92,
    "text": " and you have that patient again with 62 you may wonder if you want again to"
  },
  {
    "start": 804.92,
    "end": 808.92,
    "text": " know if he's h-bilory infected but without the absence of superficial"
  },
  {
    "start": 808.92,
    "end": 812.44,
    "text": " illusions and in the absence of you and the"
  },
  {
    "start": 812.44,
    "end": 816.92,
    "text": " patient wishing to know for some reason infection for h-bilory"
  },
  {
    "start": 816.92,
    "end": 822.68,
    "text": " once you establish the phenotype surveil that patient if it is to be surveilled"
  },
  {
    "start": 822.68,
    "end": 828.2,
    "text": " without biopsies. So in summary Mario it's important for the endoscopists to"
  },
  {
    "start": 828.2,
    "end": 832.84,
    "text": " describe whether they found actually and then describe whether it's present in"
  },
  {
    "start": 832.84,
    "end": 836.28,
    "text": " the entrum, whether it's extending into the insidiora,"
  },
  {
    "start": 836.28,
    "end": 840.04,
    "text": " whether it's extending into the body and similarly recognize"
  },
  {
    "start": 840.04,
    "end": 845.8,
    "text": " into some place here describe the extent of it whether restricted to the"
  },
  {
    "start": 845.8,
    "end": 850.44,
    "text": " entrum going up to the body and subdivision they can always say it's"
  },
  {
    "start": 850.44,
    "end": 854.12,
    "text": " kind of in the end to open up how extensively it's extending"
  },
  {
    "start": 854.12,
    "end": 860.6,
    "text": " and then take biopsies and if you've left out the biopsy from the insidiora"
  },
  {
    "start": 860.6,
    "end": 864.12,
    "text": " previous guidelines were recommending that's no longer"
  },
  {
    "start": 864.12,
    "end": 868.28,
    "text": " required and you said that there's just two biopsies"
  },
  {
    "start": 868.28,
    "end": 872.52,
    "text": " from the entrum two biopsies from the body."
  },
  {
    "start": 872.52,
    "end": 876.84,
    "text": " Now why did you leave out insidiora biopsies anymore in the new guidelines?"
  },
  {
    "start": 876.84,
    "end": 882.12,
    "text": " Yeah again it's not left out it became optional because"
  },
  {
    "start": 882.12,
    "end": 885.56,
    "text": " there are three moments in the story in the history of this"
  },
  {
    "start": 885.56,
    "end": 889.96,
    "text": " suggestion of assessing both compartments. The first"
  },
  {
    "start": 889.96,
    "end": 893.72,
    "text": " descriptions were only with two plus two biopsies"
  },
  {
    "start": 893.72,
    "end": 897.4,
    "text": " then the modified Sydney Houston system"
  },
  {
    "start": 897.4,
    "end": 901.8,
    "text": " included insidiora biopsies because that can be eventually the"
  },
  {
    "start": 901.8,
    "end": 905.4,
    "text": " line where most consistently changes occur and also"
  },
  {
    "start": 905.4,
    "end": 909.16,
    "text": " each part of it can be found but and then of course the"
  },
  {
    "start": 909.16,
    "end": 912.12,
    "text": " systems for staging atrophic antestameter pleasure"
  },
  {
    "start": 912.12,
    "end": 917.96,
    "text": " used that insidiora biopsy biopsies in the insidiora and then the maps came"
  },
  {
    "start": 917.96,
    "end": 922.2,
    "text": " again suggesting only two plus two so there was some confusion and recently"
  },
  {
    "start": 922.2,
    "end": 925.88,
    "text": " also in another consensus regained consensus that also"
  },
  {
    "start": 925.88,
    "end": 929.56,
    "text": " challenged everyone to read led by professor Ruga."
  },
  {
    "start": 929.56,
    "end": 932.84,
    "text": " There was some consensus on dropping as mandatory"
  },
  {
    "start": 932.84,
    "end": 936.12,
    "text": " the biopsies in insidiora because it doesn't have the number needed"
  },
  {
    "start": 936.12,
    "end": 940.04,
    "text": " to biopsy it was considered to be very high to add"
  },
  {
    "start": 940.04,
    "end": 943.88,
    "text": " information of course for those that in clinical practice they want"
  },
  {
    "start": 943.88,
    "end": 948.76,
    "text": " to continue to include and send in the same jar as the entrant that's fine"
  },
  {
    "start": 948.76,
    "end": 951.8,
    "text": " as long as they don't separate in a different jar because then it's the"
  },
  {
    "start": 951.8,
    "end": 956.2,
    "text": " environment that it's affected. There was an argument that I was"
  },
  {
    "start": 956.2,
    "end": 960.12,
    "text": " sensitive to recently that was some suggested that for"
  },
  {
    "start": 960.12,
    "end": 965.32,
    "text": " for making the biopsies in insidiora you would take more time looking at insidiora."
  },
  {
    "start": 965.32,
    "end": 968.6,
    "text": " Maybe that's reasonable but there is no evidence to suggest that so"
  },
  {
    "start": 968.6,
    "end": 973.16,
    "text": " what I said in that lecture that someone let's say posed"
  },
  {
    "start": 973.16,
    "end": 977.08,
    "text": " this argument was that we need more research in this field to show definitely"
  },
  {
    "start": 977.08,
    "end": 981.56,
    "text": " if we need or not the"
  },
  {
    "start": 981.56,
    "end": 983.89,
    "text": " biases or biopsies. So for those that continue to do it, they are not against the guidelines."
  },
  {
    "start": 983.89,
    "end": 988.01,
    "text": " For those that don't want to do it, they want to look carefully and use endoscopic"
  },
  {
    "start": 988.01,
    "end": 993.69,
    "text": " staging rather than making a further biopsy, another biopsy that's fine now. Don't focus"
  },
  {
    "start": 993.69,
    "end": 999.47,
    "text": " too much on biopsies. That's, I think, also a nice message because it's you trust your"
  },
  {
    "start": 999.47,
    "end": 1004.61,
    "text": " eyes, learn how to scope, learn how to recognize and the biopsies will further help. It's the"
  },
  {
    "start": 1004.61,
    "end": 1010.85,
    "text": " same process you were first and before alluding to US and CT scans for lesions that we do"
  },
  {
    "start": 1010.85,
    "end": 1016.53,
    "text": " consider that we will treat them in this case. And this is in the West because in the East,"
  },
  {
    "start": 1016.53,
    "end": 1022.01,
    "text": " for ages, they don't do biopsies to assess a traffic change. They don't test them at"
  },
  {
    "start": 1022.01,
    "end": 1027.85,
    "text": " the plage and so they trust their eyes and they stage endoscopically the stomach."
  },
  {
    "start": 1027.85,
    "end": 1033.37,
    "text": " Yeah, that's one thing I've seen which is different. So Mario, let's say I've got the"
  },
  {
    "start": 1033.37,
    "end": 1038.13,
    "text": " endoscopy description, I've got exactly the extent and I had the histology results. There's"
  },
  {
    "start": 1038.13,
    "end": 1044.33,
    "text": " a bit of complex grid that the guideline has recommended in terms of deciding what qualifier"
  },
  {
    "start": 1044.33,
    "end": 1051.61,
    "text": " surveillance and who do not qualify for surveillance. And we can follow that. Is there a simpler way"
  },
  {
    "start": 1051.61,
    "end": 1058.13,
    "text": " to summarizing the whole thing in one golden rule? Let's say who needs to be surveyed and"
  },
  {
    "start": 1058.13,
    "end": 1065.49,
    "text": " who doesn't need to be surveyed. Yeah. So most individuals will not require surveillance."
  },
  {
    "start": 1065.49,
    "end": 1073.13,
    "text": " So most will have what we can call almost normal changes of minor atrophic changes in the"
  },
  {
    "start": 1073.13,
    "end": 1078.37,
    "text": " entrum and some scattered spots of emplacement at the plage. So for those individuals, we"
  },
  {
    "start": 1078.37,
    "end": 1085.33,
    "text": " do not recommend surveillance with the exception of having some family history in their families."
  },
  {
    "start": 1085.33,
    "end": 1092.45,
    "text": " Again, neither the country or ethnicity seems to affect the surveillance rate. Okay. Eventually"
  },
  {
    "start": 1092.45,
    "end": 1098.69,
    "text": " if we come back to a screening program, again, as I said before, if these individuals come"
  },
  {
    "start": 1098.69,
    "end": 1106.97,
    "text": " for the astroscopy and if he has or he belongs to a specific ethnicity, he may return to"
  },
  {
    "start": 1106.97,
    "end": 1114.85,
    "text": " the screening protocol. For a subset of patients, it varies from subgroup to country. So it"
  },
  {
    "start": 1114.85,
    "end": 1119.09,
    "text": " correlates with the risk of gastric cancer. But for some group that is estimated between"
  },
  {
    "start": 1119.09,
    "end": 1126.37,
    "text": " three and 5% to 10% in the high risk countries, we may have to surveil these patients every"
  },
  {
    "start": 1126.37,
    "end": 1131.65,
    "text": " three years. Those patients with extensive intestinal metoplasia, but don't mix up here"
  },
  {
    "start": 1131.65,
    "end": 1136.49,
    "text": " the extensive intestinal metoplasia that sometimes you see in the reports of pathologists that"
  },
  {
    "start": 1136.49,
    "end": 1142.41,
    "text": " refers to a specific site. It's again, the report of endoscopy that you've done saying,"
  },
  {
    "start": 1142.41,
    "end": 1148.01,
    "text": " \"I do see trophic changes in the entron, in caesural and corpus, with a lot of changes"
  },
  {
    "start": 1148.01,
    "end": 1153.05,
    "text": " that I recognize as endoscopy, both in the entron and both in the corpus.\" And eventually"
  },
  {
    "start": 1153.05,
    "end": 1158.73,
    "text": " even if you don't see them, if you have reports from pathology reporting, endoscopy in both"
  },
  {
    "start": 1158.73,
    "end": 1163.93,
    "text": " compartments, you should surveil these patients. This is an easy rule for them to surveil patients."
  },
  {
    "start": 1163.93,
    "end": 1169.41,
    "text": " Yeah, that's very nice to simplify, Mario, because often I think the endoscopy may report"
  },
  {
    "start": 1169.41,
    "end": 1173.73,
    "text": " or there's just changes in the entron. Histopathologist says, \"Listen, I've seen intestinal metoplasia"
  },
  {
    "start": 1173.73,
    "end": 1180.61,
    "text": " in the body, the corpus, and you take the worst of the devil, you take what's the worst"
  },
  {
    "start": 1180.61,
    "end": 1185.85,
    "text": " grading,\" so to say, because the endoscopist must have missed something, or histopathologists"
  },
  {
    "start": 1185.85,
    "end": 1193.17,
    "text": " may have missed. Yeah, that's why in the guideline we also present the table or picture where"
  },
  {
    "start": 1193.17,
    "end": 1201.13,
    "text": " we correlate both concepts, because actually when you speak about false negatives or false"
  },
  {
    "start": 1201.13,
    "end": 1207.13,
    "text": " positives of this endoscopic markers, you need to consider that the multifocality of"
  },
  {
    "start": 1207.13,
    "end": 1212.97,
    "text": " these changes may lead to, let's say, someone not finding an endoscopic finding that you"
  },
  {
    "start": 1212.97,
    "end": 1217.73,
    "text": " describe just because you missed the spot where you did the biopsy or the other way around."
  },
  {
    "start": 1217.73,
    "end": 1223.41,
    "text": " And also, pathologies are not that reliable when they assess a trophy, and that's why"
  },
  {
    "start": 1223.41,
    "end": 1229.65,
    "text": " we didn't do that step about suggesting to use only intestinal metoplasia, but there"
  },
  {
    "start": 1229.65,
    "end": 1235.81,
    "text": " is a sentence there in the text, we suggested intestinal metoplasia should be the most reliable"
  },
  {
    "start": 1235.81,
    "end": 1242.49,
    "text": " marker, and again, you eventually further select the patients only for a third set of"
  },
  {
    "start": 1242.49,
    "end": 1247.61,
    "text": " patients to be surveilled. Again, the concern is again, yes, you should do the strong scopy,"
  },
  {
    "start": 1247.61,
    "end": 1252.21,
    "text": " yes, you should do it properly, yes, you should not miss a cancer, you should use all the"
  },
  {
    "start": 1252.21,
    "end": 1257.25,
    "text": " technologies that you have in front of you to not miss anyone, but then please, please,"
  },
  {
    "start": 1257.25,
    "end": 1261.77,
    "text": " please take care only of those that merit surveillance, because there is evidence to"
  },
  {
    "start": 1261.77,
    "end": 1267.61,
    "text": " suggest that those are the ones at risk. It's again, it's not a very strong evidence, but"
  },
  {
    "start": 1267.61,
    "end": 1272.89,
    "text": " it's consistent. It's consistent to say, and it's the best marker we have. I would say"
  },
  {
    "start": 1272.89,
    "end": 1280.09,
    "text": " that what I expect is that the schedule in three years will probably be even that too"
  },
  {
    "start": 1280.09,
    "end": 1286.49,
    "text": " often or too intensive, because we saw that for the polyps in the colon, we saw that for"
  },
  {
    "start": 1286.49,
    "end": 1291.17,
    "text": " merits. So the more we learn with this, probably in a few years we will say, okay, there is"
  },
  {
    "start": 1291.17,
    "end": 1297.09,
    "text": " another marker that we should use, much better than using these trophic changes."
  },
  {
    "start": 1297.09,
    "end": 1302.81,
    "text": " Okay, so the most important thing is endoscopic description by the endoscopist, and histopathological"
  },
  {
    "start": 1302.81,
    "end": 1307.21,
    "text": " interpretation, a good histopathologist is saying things that you combine those and come"
  },
  {
    "start": 1307.21,
    "end": 1312.81,
    "text": " up with whether the patient needs surveillance or not. Now, Mario, what are the common mistakes"
  },
  {
    "start": 1312.81,
    "end": 1318.17,
    "text": " that you come across in clinical practice in terms of assignment of surveillance? You"
  },
  {
    "start": 1318.17,
    "end": 1321.97,
    "text": " may have come across, I've got some examples, but you probably will be, you come across"
  },
  {
    "start": 1321.97,
    "end": 1329.05,
    "text": " more of these. Can you explain to us what we can learn from where we get things wrong?"
  },
  {
    "start": 1329.05,
    "end": 1335.33,
    "text": " So when we already discussed is not stopping, not stopping surveillance, I think it's something"
  },
  {
    "start": 1335.33,
    "end": 1342.81,
    "text": " that we see often because, again, we have an ageing population. Secondly, I think we"
  },
  {
    "start": 1342.81,
    "end": 1349.29,
    "text": " somehow, we continue to see patients that do have intestinal pleasure, but only mild"
  },
  {
    "start": 1349.29,
    "end": 1355.49,
    "text": " changes in the endome and those should not be surveilled. And yeah, on the other side"
  },
  {
    "start": 1355.49,
    "end": 1361.69,
    "text": " eventually, for some reason that let's say we don't, and then we observe that also in"
  },
  {
    "start": 1361.69,
    "end": 1368.69,
    "text": " other, let's say areas in other diseases, again, such as Barrett, that these two over surveilled"
  },
  {
    "start": 1368.69,
    "end": 1374.81,
    "text": " patients with extensive intestinal pleasure. So sometimes I see both sides of the coin"
  },
  {
    "start": 1374.81,
    "end": 1380.29,
    "text": " and living in Portugal, I tend to see over surveillance more than under surveillance."
  },
  {
    "start": 1380.29,
    "end": 1387.05,
    "text": " But I can, I also anticipate that this is seen in other countries the other way around"
  },
  {
    "start": 1387.05,
    "end": 1392.89,
    "text": " saying, okay, oh, I have a patient that does not come from a specific ethnicity, does not"
  },
  {
    "start": 1392.89,
    "end": 1398.05,
    "text": " come from a specific country. Even though there is intestinal pleasure everywhere, I"
  },
  {
    "start": 1398.05,
    "end": 1404.29,
    "text": " will not surveil this patient. This is called, it may lead to a missed opportunity for prevention."
  },
  {
    "start": 1404.29,
    "end": 1410.73,
    "text": " I can tell you where I stand within the UK. Now, I think we have a tendency to under-call,"
  },
  {
    "start": 1410.73,
    "end": 1417.13,
    "text": " we have a tendency to not diagnose patients, and we have a tendency to under-survey rather"
  },
  {
    "start": 1417.13,
    "end": 1421.49,
    "text": " than over, I think that's the way, that's the trend I tend to see locally."
  },
  {
    "start": 1421.49,
    "end": 1428.09,
    "text": " So coming on to the next sub-discussion, can you briefly discuss about any risk factors?"
  },
  {
    "start": 1428.09,
    "end": 1433.77,
    "text": " We know the helicobacter pylori is the main risk factor in most gastric cancers or intestinal"
  },
  {
    "start": 1433.77,
    "end": 1439.61,
    "text": " type related to that. What are the other risk factors that we need to be aware of?"
  },
  {
    "start": 1439.61,
    "end": 1445.33,
    "text": " Well, again, we focused here in, again, gastric cancer related to the helicobacter pylori,"
  },
  {
    "start": 1445.33,
    "end": 1451.33,
    "text": " but of course, in the stomach, we also have the upper part that may have other factors,"
  },
  {
    "start": 1451.33,
    "end": 1457.01,
    "text": " but it's quite consistent the role of smoking. So in all the patients, in all the patients,"
  },
  {
    "start": 1457.01,
    "end": 1463.29,
    "text": " you should suggest it's not smoking, specifically in these patients. It's not, it's not the"
  },
  {
    "start": 1463.29,
    "end": 1469.05,
    "text": " infrequent that patients are very, let's say, concerned about cancer, but they do smoke."
  },
  {
    "start": 1469.05,
    "end": 1474.93,
    "text": " And there is some evidence also suggesting an alcohol effect. Again, we are, let's say,"
  },
  {
    "start": 1474.93,
    "end": 1480.49,
    "text": " less, less intensively suggesting to moderate the consumption of alcohol. There may be a"
  },
  {
    "start": 1480.49,
    "end": 1488.43,
    "text": " role for protective factors rather than risk factors. Beyond aspirin, we could not suggest"
  },
  {
    "start": 1488.43,
    "end": 1495.53,
    "text": " any other potentially medication that could be of benefit for these patients. Even for"
  },
  {
    "start": 1495.53,
    "end": 1500.85,
    "text": " aspirin, we suggested that for those at the high risk of having cardiovascular diseases"
  },
  {
    "start": 1500.85,
    "end": 1508.73,
    "text": " that may cure inside in terms of age for this disease. So stop smoking, eradicate the pylori"
  },
  {
    "start": 1508.73,
    "end": 1515.61,
    "text": " and eventually ingest more antioxidants. So in terms of eradication of H. pylori, does"
  },
  {
    "start": 1515.61,
    "end": 1521.33,
    "text": " it have a benefit? Once patients have already developed these three million changes or even,"
  },
  {
    "start": 1521.33,
    "end": 1526.73,
    "text": " let's say, patients have already had dysplastic changes or even early gastric cancer, let's"
  },
  {
    "start": 1526.73,
    "end": 1532.49,
    "text": " say patients were found to have alkypectopylori positive, would that benefit at that stage"
  },
  {
    "start": 1532.49,
    "end": 1538.73,
    "text": " then you've gone beyond, you've gone to a stage of chronic changes. So starting from"
  },
  {
    "start": 1538.73,
    "end": 1544.89,
    "text": " the end, if you do have a patient with an early gastric cancer, you need to eradicate"
  },
  {
    "start": 1544.89,
    "end": 1551.21,
    "text": " H. pylori because it's a risk factor for having further lesions during surveillance. If, of"
  },
  {
    "start": 1551.21,
    "end": 1556.97,
    "text": " course, if you detect a patient with H. pylori with no lesions, this is the best moment to"
  },
  {
    "start": 1556.97,
    "end": 1562.73,
    "text": " eradicate H. pylori because then you, let's say, delete the risk factor or you abolish the risk"
  },
  {
    "start": 1562.73,
    "end": 1569.69,
    "text": " factor for all the cascade. And there is some discrepancy in the data about further stages"
  },
  {
    "start": 1569.69,
    "end": 1574.89,
    "text": " and the effect of H. pylori. It's quite consistent on some effect in the atrophic, when there is"
  },
  {
    "start": 1574.89,
    "end": 1580.01,
    "text": " some atrophic changes, there is some controversy when there is established indefinite plagiarism,"
  },
  {
    "start": 1580.01,
    "end": 1585.61,
    "text": " so-called point of marital. We need to revisit all this literature because most of that was"
  },
  {
    "start": 1585.61,
    "end": 1591.45,
    "text": " based on old endoscopies, random biopsies with a multifocality of these processes."
  },
  {
    "start": 1591.45,
    "end": 1597.93,
    "text": " And there is a strong data suggesting that H. pylori, even at an old age, has an effect"
  },
  {
    "start": 1597.93,
    "end": 1603.93,
    "text": " in reducing the risk. Why do I speak with all about the old age? Because it leads also to"
  },
  {
    "start": 1603.93,
    "end": 1609.05,
    "text": " significant atrophic changes in the decimator process. So probably if you have a decimator,"
  },
  {
    "start": 1609.05,
    "end": 1614.49,
    "text": " if you have H. pylori, even though if it doesn't regress, it may hold on the process,"
  },
  {
    "start": 1614.49,
    "end": 1620.09,
    "text": " even if you don't observe it, because it may take a while to observe that long-term effect"
  },
  {
    "start": 1620.09,
    "end": 1626.33,
    "text": " of eradication. So eradicate H. pylori, of course, if you search for that, but balancing"
  },
  {
    "start": 1626.33,
    "end": 1630.89,
    "text": " with the patient in front of you. And again, it comes with the age and the effects of eradication,"
  },
  {
    "start": 1630.89,
    "end": 1636.01,
    "text": " etc. But to make it simple, you should eradicate all the time in this setting."
  },
  {
    "start": 1636.01,
    "end": 1642.25,
    "text": " Yeah, at any stage. Okay, lovely. That's better, that's good to learn. One of the most important"
  },
  {
    "start": 1642.25,
    "end": 1647.85,
    "text": " questions that I get when I speak to patients from a patient perspective is what they see"
  },
  {
    "start": 1647.85,
    "end": 1654.49,
    "text": " and hear in media about proton pump inhibitors and risk of gastric cancer. I think I can see that"
  },
  {
    "start": 1654.49,
    "end": 1659.37,
    "text": " you made the guideline can just make some recommendation on that. Can you just clarify"
  },
  {
    "start": 1659.37,
    "end": 1666.33,
    "text": " what is the stance from the guideline committee about this and how we need to approach this"
  },
  {
    "start": 1666.33,
    "end": 1672.73,
    "text": " with our patients? So if the patient truly has an indication to take VPI, reflux disease,"
  },
  {
    "start": 1672.73,
    "end": 1681.61,
    "text": " NSA, it's with a previous history of apoptic ulcer disease. So any reason that you and the patient"
  },
  {
    "start": 1681.61,
    "end": 1688.17,
    "text": " agree that he should continue to have VPI, he should be, let's say, less concerned about that"
  },
  {
    "start": 1688.17,
    "end": 1692.65,
    "text": " in terms of risk of gastric cancer. There is also, there is some suggestion that it may increase,"
  },
  {
    "start": 1692.65,
    "end": 1698.33,
    "text": " it may lead to, of course, apocloridia and also some effect in terms of progression,"
  },
  {
    "start": 1698.33,
    "end": 1703.85,
    "text": " but that does not, let's say, that should not, in any case, and also not only for this,"
  },
  {
    "start": 1703.85,
    "end": 1710.25,
    "text": " in any case, preclude the fact that that patient will have a better quality of life if that's the"
  },
  {
    "start": 1710.25,
    "end": 1715.77,
    "text": " outcome that we pursue or prevention of recurrence and also in the routine."
  },
  {
    "start": 1715.77,
    "end": 1720.41,
    "text": " The paradox sometimes is installed because some of these patients are deeply concerned about"
  },
  {
    "start": 1720.41,
    "end": 1726.33,
    "text": " cancer, but they do smoke, they are overweight, they have other risk factors, and they are so"
  },
  {
    "start": 1726.33,
    "end": 1732.57,
    "text": " concerned about VPI. So we need to also use this opportunity to make an holistic approach to this"
  },
  {
    "start": 1732.57,
    "end": 1740.89,
    "text": " patient and try to convince them to make primary changes that will be, let's say, more consistent"
  },
  {
    "start": 1740.89,
    "end": 1748.17,
    "text": " with a better health life than only the topic of cancer. So the bottom line is to reassure,"
  },
  {
    "start": 1749.13,
    "end": 1754.09,
    "text": " I guess, and patients that there's real good indication, continue and reassure."
  },
  {
    "start": 1754.09,
    "end": 1758.81,
    "text": " So, Marie, I've left out the discussion on management displays here and early gastric"
  },
  {
    "start": 1758.81,
    "end": 1763.77,
    "text": " cancer from this because I think that's a very specialist field. We need another hour to discuss"
  },
  {
    "start": 1763.77,
    "end": 1769.21,
    "text": " that, so we'll leave that out. Thanks for covering all the aspects and the guidelines have been"
  },
  {
    "start": 1769.21,
    "end": 1776.17,
    "text": " written so nicely, the charts are amazing, the diagrams are really good, and I do ask the"
  },
  {
    "start": 1776.17,
    "end": 1781.93,
    "text": " listeners to read that, although it's 40 pages, it is a good read. Now, what I couldn't understand,"
  },
  {
    "start": 1781.93,
    "end": 1786.97,
    "text": " oh, I found it fascinating, is why maps, where did this come from? Thank you for the question."
  },
  {
    "start": 1786.97,
    "end": 1792.01,
    "text": " So you challenge the readers to read, and I challenge the readers and the researchers to"
  },
  {
    "start": 1792.01,
    "end": 1798.97,
    "text": " push and also challenge the guidelines because we need more evidence to continue to suggest what"
  },
  {
    "start": 1798.97,
    "end": 1805.93,
    "text": " you suggested or to change what we suggested. So please come with good research. So the maps,"
  },
  {
    "start": 1805.93,
    "end": 1812.17,
    "text": " the maps acronym, I think it was, let's say, during a discussion as this one,"
  },
  {
    "start": 1812.17,
    "end": 1819.69,
    "text": " reading at the title that we were giving to the guideline that goes for management of patients"
  },
  {
    "start": 1819.69,
    "end": 1828.81,
    "text": " with pre-cancerous conditions in the stomach, so management and pre-cancerous and stomach,"
  },
  {
    "start": 1828.81,
    "end": 1835.77,
    "text": " the S, and it was nicely, let's say, crystallized with maps because it refers to a message that we"
  },
  {
    "start": 1835.77,
    "end": 1841.69,
    "text": " already alluded during this discussion that you should map the stomach, you should make an overview"
  },
  {
    "start": 1841.69,
    "end": 1848.65,
    "text": " of the entire mucosa, and you should take biopsies. So the maps goes for the main message of the"
  },
  {
    "start": 1848.65,
    "end": 1853.77,
    "text": " management of these patients, that you should look at the stomach as a whole and make a map."
  },
  {
    "start": 1853.77,
    "end": 1860.97,
    "text": " You were involved in most iterations of the maps, is that correct? So how did the journey"
  },
  {
    "start": 1860.97,
    "end": 1869.69,
    "text": " start with all this? Yeah, so I dedicated most of my PhD thesis to this topic and then in 2008,"
  },
  {
    "start": 1869.69,
    "end": 1878.25,
    "text": " I was elected council for ESG and by chance, Ernst Kuipers, also very much interested in this"
  },
  {
    "start": 1878.25,
    "end": 1883.69,
    "text": " topic and also Professor Fatima Carnero, she is Portuguese and she was the president of European"
  },
  {
    "start": 1883.69,
    "end": 1890.25,
    "text": " Society of Pathology. So there was a coincidence that in the three boards, there were people"
  },
  {
    "start": 1890.25,
    "end": 1895.53,
    "text": " interested in this topic, that is, even though it's kind of, let's say, gastric cancer is considered"
  },
  {
    "start": 1895.53,
    "end": 1902.41,
    "text": " to be rare in Europe, you find gastritis and the management of these patients every day"
  },
  {
    "start": 1902.41,
    "end": 1908.81,
    "text": " in your clinical practice. Like coincidence, the fact that we have a network, this is also a nice"
  },
  {
    "start": 1908.81,
    "end": 1915.93,
    "text": " message, we were able to convince our societies that we could join forces and then for that first"
  },
  {
    "start": 1915.93,
    "end": 1922.57,
    "text": " edition, I was the first author. For the second edition, I was honored to be the last and then"
  },
  {
    "start": 1922.57,
    "end": 1927.61,
    "text": " this time I became again the first. So let's see how it goes for the next four and five years."
  },
  {
    "start": 1927.61,
    "end": 1936.73,
    "text": " The network is very important and to change what we do. I'm glad leaders like you"
  },
  {
    "start": 1936.73,
    "end": 1943.29,
    "text": " exist who take initiative in these things and I'm very glad that you have spent the last"
  },
  {
    "start": 1943.29,
    "end": 1948.57,
    "text": " one or two hours discussing this with us today. Thanks for the EEG for everything."
  },
  {
    "start": 1948.57,
    "end": 1954.01,
    "text": " No, thank you for inviting me and it's an honor and a pleasure always to discuss about this and"
  },
  {
    "start": 1954.01,
    "end": 1957.77,
    "text": " other topics. So see you soon. Thanks Mario. Bye bye."
  }
]