Artificial intelligence for endoscopic grading of gastric intestinal metaplasia: advancing risk stratification for gastric cancer

Abstract

Background

The Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) classification correlates with histological assessment of gastric intestinal metaplasia and enables stratification of gastric cancer risk. We developed and evaluated an artificial intelligence (AI) approach for EGGIM estimation.

Methods

Two datasets (A and B) with 1280 narrow-band imaging images were used for per-image analysis. Still images with manually selected patches of 224 × 224 pixels, annotated by experts, were used. Dataset A was retrospectively collected from clinical routine; Dataset B (used for per-patient analysis) was prospectively collected and included 65 fully documented patients. To mimic clinical practice, a deep neural network classified image patches into three EGGIM classes (0, 1, 2) and calculated the total per-patient EGGIM score (0–10).

Results

On per-image analysis, an accuracy of 87% (95%CI 71%–100%) was obtained. Per-patient EGGIM estimation had an average error of 1.15 (out of 10) and showed 88% (95%CI 80%–96%) accurate clinical decisions for surveillance (EGGIM ≥5), with 85% (95%CI 75%–94%) specificity, no false negatives, and positive and negative predictive values of 62% (95%CI 32%–92%) and 100% (95%CI 100%–100%), respectively.

Conclusions

EGGIM was estimated with high accuracy using AI tools in endoscopic image analyses. Automated assessment of EGGIM may provide a greener strategy for gastric cancer risk stratification, prospective studies, and interventional trials.

Publication History

Received: 24 February 2025

Accepted after revision: 27 May 2025

Accepted Manuscript online:
17 July 2025

Article published online:
08 September 2025

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