Abstract
Background and study aims Atrophic gastritis (AG) and intestinal metaplasia (IM) are premalignant conditions
of gastric cancer and endoscopic recognition and characterization may help in stratifying
the gastric cancer risk for screening and surveillance. However, there is currently
lack of consensus in defining the severity of AG and IM. We aimed to conduct an international
survey to understand the current practice of endoscopists worldwide.
Methods An online survey was designed to collect data regarding participants’ practice in
endoscopic assessment of AG & IM. A test using images was conducted to evaluate the
difference in accuracy of characterization of AG & IM.
Results From July to October 2017, 249 endoscopists responded to the survey. Around 70 % of
participants received some form of training on recognition of AG & IM. There was significant
variety in the training received across different continents. One hundred seventy-six
participants (70 %) would document the presence of both AG and IM, but the classification
systems used were inconsistent between endoscopists. Overall accuracy in diagnosis
of AG & IM in the image test was 84.5 % and 80.7 % respectively. The diagnostic accuracy
was significantly higher among Japanese and Korean endoscopists compared to the rest
of the world.
Conclusion Training regarding endoscopic recognition of AG & IM differs significantly in different
parts of the world. The difference in diagnostic accuracy for these premalignant gastric
conditions may also explain the discrepancy in the early cancer detection rates among
different countries. A simple unified classification system may be beneficial for
better stratification of cancer risks.
