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Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia: can we replace histology assessment also in the West?
  1. Pedro Marcos1,2,
  2. Gisela Brito-Gonçalves3,
  3. Diogo Libânio1,4,
  4. Inês Pita1,
  5. Rui Castro1,
  6. Inês Sá1,
  7. Mário Dinis-Ribeiro1,4,
  8. Pedro Pimentel-Nunes1,4,5
  1. 1 Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
  2. 2 Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
  3. 3 Faculty of Medicine, University of Porto, Porto, Portugal
  4. 4 MEDCIS, Faculty of Medicine, University of Porto, Porto, Portugal
  5. 5 Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
  1. Correspondence to Dr Pedro Marcos, Serviço de Gastrenterologia, Centro Hospitalar de Leiria, Rua das Olhalvas, 2410-197, Leiria, Portugal; pedromarcos1ster{at}


Objectives To 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.

Design Single 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.

Results More 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).

Conclusion This 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.

  • gastritis
  • endoscopy
  • gastric cancer
  • gastric intestinal metaplasia

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  • Contributors PM, GBG, DL, IP, RC and IS contributed to the data collection. PM made the statistical analysis, interpreted the data, reviewed the literature and drafted the manuscript. DL, MDR and PPN contributed to the analysis and interpretation of data, and reviewed the language and intellectual content of this work. GBG, RC, IP and IS revised the final draft of the study. MDR and PPN contributed to the conception of the study design and approved the final version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Ethics Committee of Portuguese Oncology Institute of Porto (Portugal) approved this study. The study followed the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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