Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia: can we replace histology assessment also in the West?

Abstract

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.

Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions

“…Based on the multifocal patterns of IM, an endoscopic mucosal examination of the entire stomach is recommended[ 47 ]. Marcos et al [ 48 ] reported that NBI endoscopic grading of IM was useful for risk assessment of early gastric neoplasia.…”

hsa_circ_0060975 is highly expressed and predicts a poor prognosis in gastric cancer

“…The treatment effect for poorly differentiated GC remains poor ( 33 , 61 ) and it has been demonstrated that poorly differentiated GC is a hotspot in clinical treatment research ( 35 ). GC is divided into early GC (stage I and II) and advanced GC (stage III or higher tumors) ( 36 – 38 ), and there are differences in treatment and surgical methods between early and advanced GC ( 39 , 40 ). Uzun et al ( 41 ) revealed that T1-T2 and T3-T4 classifications of patients with GC showed differences in their clinicopathological characteristics and survival status.…”

“…According to WHO's fifth edition of gastric cancer differentiation standard ( 32 ), the clinical characteristics and prognosis of patients with GC with well-moderately differentiated and patients with GC with poorly-signet differentiated were different ( 33 – 35 ), patients with GC with regards to histological grade were divided into the well-moderately group and poorly-signet group. According to the American Joint Committee on Cancer Staging System (8 th edition) ( 31 ), and the differences in treatment and surgical methods between early gastric cancer group (stage I and II) and advanced gastric cancer group (stage III or higher tumors) ( 36 – 40 ), patients with GC with regards to pathological stage were divided into the early GC group (stage I and II) and advanced GC group (stage III or higher tumors). According to the United States Joint Committee on Cancer Staging System (8 th edition) ( 31 ) and the differences between T3-T4 group and T1-T2 classification group with GC in chemotherapy and surgery ( 41 – 43 ), patients with GC in tumor (T) classification were divided into the T1-T2 and T3-T4 groups.…”

Original Article: MicroRNA Dysregulation in the Gastric Carcinogenesis Cascade: Can We Anticipate Its Role in Individualized Care?

“…From February 2016 to November 2018, patients who were submitted to upper gastrointestinal endoscopy with high-definition virtual chromoendoscopy were prospectively screened for inclusion in this study. They were included if they could be classified in one of the 3 groups as follows: (A) controls with no/slight gastric atrophy or metaplasia (Operative Link for Gastritis Assessment [OLGA] stage 0-II and Operative Link for Gastric Intestinal Metaplasia [OLGIM] stage 0-II, and Endoscopic Grading of Gastric Intestinal Metaplasia [EGGIM] grade 0-4 [33][34][35]); (B) extensive atrophy/intestinal metaplasia (OLGA stage III-IV or OLGIM stage III-IV or EGGIM ≥ 5) and no history of gastric neoplasia; and (C) patients with EGN (visible lesion with dysplasia or early adenocarcinoma). Hp status was assessed by pathology analysis of antrum and corpus biopsy samples using the modified Giemsa stain.…”