ObjectivesTo assess the value of endoscopic grading of gastric intestinal metaplasia (EGGIM), operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric neoplasia (EGN) and to investigate other factors possibly associated with its development.DesignSingle centre, case–control study including 187 patients with EGN treated endoscopically and 187 age-matched and sex-matched control subjects. Individuals were classified according to EGGIM, OLGA and OLGIM systems. EGN risk according to gastritis stages and other clinical parameters was further evaluated.ResultsMore patients with EGN had EGGIM of ≥5 than control subjects (68.6% vs 13.3%, p<0.001). OLGA and OLGIM stages III/IV were more prevalent in patients with EGN than in control subjects (68% vs 11%, p<0.001, and 61% vs 3%, p<0.001, respectively). The three systems were the only parameters significantly related to the risk of EGN in multivariate analysis: for EGGIM 1–4 (adjusted OR (AOR) 12.9, 95% CI 1.4 to 118.6) and EGGIM 5–10 (AOR 21.2, 95% CI 5.0 to 90.2); for OLGA I/II (AOR 5.0, 95% CI 0.56 to 44.5) and OLGA III/IV (AOR 11.1, 95% CI 3.7 to 33.1); for OLGIM I/II (AOR 11.5, 95% CI 4.1 to 32.3) and OLGIM III/IV (AOR 16.0, 95% CI 7.6 to 33.4).ConclusionThis study confirms the role of histological assessment as an independent risk factor for gastric cancer (GC), but it is the first study to show that an endoscopic classification of gastric intestinal metaplasia is highly associated with that outcome. After further prospective validation, this classification may be appropriate for GC risk stratification and may simplify every day practice by reducing the need for biopsies.

<b><i>Background:</i></b> Endoscopic submucosal dissection (ESD) is a treatment for early gastric neoplasms that preserves the stomach. However, the risk of multiple lesions persists. <b><i>Objectives:</i></b> To assess clinicopathologic characteristics of patients with early gastric neoplasms in a Western country and evaluate risk factors for multiple gastric lesions, synchronous, or metachronous. <b><i>Methods:</i></b> A retrospective cohort of 230 consecutive patients who underwent ESD for primary neoplasms from 2012 to 2017 (median follow-up: 33 months) was assessed to determine the clinicopathologic characteristics and risk factors for multiple lesions. <b><i>Results:</i></b> The mean age was 68 years, and 53.9% were male. Current/former smoking status was present in 40.4%, and 29.5% had family history of gastric cancer. A third of the patients had only focal gastric atrophy/metaplasia (operative link on gastritis assessment/operative link on gastric intestinal metaplasia assessment [OLGA/OLGIM] I/II; endoscopic grading of gastric intestinal metaplasia [EGGIM] 1–4). Synchronous and me­tachronous lesions occurred in 14.3 and 8.6% of patients, respectively. There was a trend for higher risk of multiple lesions in smokers and patients with extensive metaplasia (EGGIM &#x3e;4), but only older age was an independent risk factor (OR 3.30; 95% CI 1.05–10.34). Age &#x3e;60 years (OR 10.10, 95% CI 1.40–88.04), current/former smoking status (OR 3.64, 95% CI 1.07–12.40), and OLGIM III/IV (OR 3.07, 95% CI 1.01–9.36) were independent risk factors for synchronous lesions. No risk factors for metachronous lesions were found. <b><i>Conclusions:</i></b> Surveillance limited to patients with advanced stages of gastritis may miss some primary superficial neoplasms. Although older age increases the risk of multiple lesions, no risk factors were found for metachronous lesions. Therefore, endoscopic surveillance after ESD should be done equally in all patients.

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