The role of the endoscopic grading of gastric intestinal metaplasia in assessing gastric cancer risk: A systematic review and meta-analysis

Abstract

Background and aimPatients with gastric intestinal metaplasia (IM) are at increased risk of gastric cancer (GC). The endoscopic grading of gastric intestinal metaplasia (EGGIM) with high-definition endoscopes has shown the potential to facilitate GC risk stratification. However, a comprehensive review and meta-analysis of published articles are lacking. We conducted a meta-analysis to access the value of EGGIM in the assessment of histological IM.MaterialsStudies were selected from PubMed, Medline, Embase, and Cochrane (last selection, Jun 2022). We extracted relevant data to calculate the accuracy of EGGIM compared with the operative link of gastric intestinal metaplasia (OLGIM) and to calculate pooled odds ratio (OR) with a 95% confidence interval (CI) assessing GC risk with different grading.ResultsFour diagnostic studies and three case-control clinical trials were included in the analysis, which included 665 patients and 738 patients, respectively. Compared with OLGIM III/IV, EGGIM(5-10) had a pooled sensitivity and specificity of 0.92(95%CI 0.86-0.96) and 0.90(95%CI 0.88-0.93), and the area under the curve(AUC) was 0.9702. In assessing early GC, the pooled OR of patients with EGGIM(5-10) was 7.46(95%CI 3.41-16.31) compared with that of EGGIM(0-4).ConclusionsEGGIM is highly consistent with OLGIM, and patients with EGGIM(5-10) are at a higher risk for early GC. Some heterogeneity in the current research suggests that we need to carry out more strict control of confounding factors.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=248691], (Prospero registration number: 248691)

Gastric Intestinal Metaplasia: Challenges and the Opportunity for Precision Prevention

“…Higher stage (OLGA/OLGIM III/IV) is associated with a higher risk of gastric cancer as compared with lower-stage atrophy/IM, as demonstrated in a meta-analysis published in 2018, where the odds ratios for gastric cancer for OLGA and OLGIM, respectively, were 2.64 (95% CI: 1.84-3.79) and 3.99 (95% CI: 3.05, 5.21). Importantly, EGGIM ≥5 has high concordance with OLGIM III/IV with an AUC of 0.97, reinforcing the role of endoscopic evaluation as a means of risk assessment [83]. However, OLGIM stage I/II still carries an increased risk of cancer.…”

“…For each region, extent is scored as 0 (no IM), 1 (≤30% IM) or 2 (>30% IM), giving a maximum score of 10. An EGGIM score ≥5 is considered higher risk, and a small 2022 meta-analysis of three studies demonstrated an odds ratio of 7.46 (95% CI 3.41 to 16.31) for early gastric neoplasia when compared with EGGIM 0-4 [83].…”