ENDOSCOPIC GRADING OF GASTRIC INTESTINAL METAPLASIA PREDICTS EARLY GASTRIC NEOPLASIA: CAN WE REPLACE HISTOLOGY ASSESSMENT ALSO IN THE WEST?

Aims To assess the predictive value of endoscopic grading of gastric intestinal metaplasia (EGGIM), operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) for early gastric neoplasia (EGN) and investigate other factors possibly associated with its development.

Methods Single center, case-control study including 187 patients with EGN treated endoscopically and 187 age- 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.

Results More EGN patients had EGGIM ≥5 than controls (68.6% vs. 13.3%, P< 0.001). OLGA and OLGIM stages III/IV were more prevalent in EGN patients than in controls (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 odds ratio (AOR) 12.9, 95%CI 1.4-118.6) and EGGIM 5-10 (AOR 21.2, 95%CI 5.0-90.2); for OLGA III/IV (AOR 11.1, 95%CI 3.7-33.1); for OLGIM I/II (AOR 11.5, 95%CI 4.1-32.3) and OLGIM III/IV (AOR 16.0, 95%CI 7.6-33.4).

Conclusions This study confirms the role of histological assessment as a predictor for gastric cancer but it is the first study to show that an endoscopic classification of gastric intestinal metaplasia is highly associated with that outcome. After proper training, this classification may be appropriate for gastric cancer risk stratification and simplify every day practice by precluding the need for biopsies.