Endoscopic grading of gastric intestinal metaplasia predicts gastric-cancer risk

Last Updated: 2020-02-25

By Will Boggs MD

NEW YORK (Reuters Health) - Higher endoscopic grading of gastric intestinal metaplasia (EGGIM) stages are associated with an increased risk of gastric cancer, researchers from Portugal report.

Among the several systems for staging gastritis, the operative link on gastritis assessment (OLGA) and the operative link on gastric intestinal metaplasia (OLGIM) are histological systems whose highest stages (III/IV) are associated with a high risk for gastric cancer. The recently validated EGGIM rates the extent of GIM from 0 to 10, and stages 5 or higher identify patients with OLGIM III/IV.

Dr. Pedro Marcos of the Portuguese Oncology Institute of Porto and Centro Hospitalar de Leiria and colleagues used data from 187 patients with early gastric neoplasia (EGN) and 187 age- and gender-matched controls without gastric neoplasia to assess the value of EGGIM, OLGA and OLGIM on risk stratification for EGN and consequently for gastric cancer (GC).

In general, patients with EGN had higher EGGIM, OLGA, and OLGIM stages than controls, and the ability to discriminate between patients with and without EGN was similar for the three systems.

In multivariate analyses, EGGIM 1-4 was associated with 12.9-fold greater adjusted odds of EGN, and EGGIM 5-10 was associated with 21.2-fold greater odds of EGN, compared with EGGIM 0, the researchers report in Gut.

By comparison, OLGA III/IV was associated with 11.1-fold greater odds of EGN (compared with OLGA 0), whereas OLGIM I/II was associated with 11.5-fold greater odds and OLGIM III/IV was associated with 16.0-fold greater odds of EGN (compared with OLGIM 0).

"This study confirms the role of histological assessment as an independent risk factor 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," the authors conclude. "After further prospective validation, this classification may be appropriate for GC risk stratification and may simplify everyday practice by reducing the need for biopsies."

Dr. Dan X. Li of Kaiser Permanente Northern California Division of Research, in Santa Clara, who has studied risks and predictors of gastric adenocarcinoma in patients with GIM and dysplasia, told Reuters Health by email, "The study findings confirmed the utility of 3 systems (EGGIM, OLGA and OLGIM) in risk assessment of early gastric neoplasia, but applying EGGIM can reduce the need for mucosal biopsy, which is an advantage, compared to the histological scoring systems OLGA and OLGIMI."

"EGGIM also requires a careful inspection of the entire gastric mucosa, rather than the 'snapshots' information obtained by mucosal biopsies," he said.

"As the authors mentioned in the paper, the study was conducted at a center of expertise on using virtual chromoendoscopy (with narrow-band imaging) to assess gastric mucosal abnormalities," Dr. Li said. "There will be a learning curve for gastroenterologists who are not familiar with this technique."

Dr. Marcos did not respond to a request for comments.

SOURCE: https://bit.ly/2SYirb4 Gut, online February 12, 2020.