Endoscopy 2021; 53(S 01): S118-S119
DOI: 10.1055/s-0041-1724568
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Surveillance and Endoscopic Recognition of Gastric Intestinal Metaplasia and Atrophic Gastritis: A Retrospective Cohort Study in Two Academic Centers

J Honing
1   University of Utrecht, University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
,
E Dieninyte
2   Vilnius University Faculty of Medicine, Vilnius, Lithuania
,
M O’Donovan
3   University of Cambridge, Addenbrooke’s University Hospital, Pathology, Cambridge, United Kingdom
,
LA Brosens
4   University of Utrecht, University Medical Center Utrecht, Pathology, Utrecht, Netherlands
,
RC Fitzgerald
5   University of Cambridge, Addenbrooke’s University Hospital, Gastroenterology, Cambridge, United Kingdom
,
BL Weusten
1   University of Utrecht, University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands
,
M di Pietro
5   University of Cambridge, Addenbrooke’s University Hospital, Gastroenterology, Cambridge, United Kingdom
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Aims Endoscopic recognition of GIM and GA is challenging and little is known regarding adherence to surveillance guidelines in Western centers, particularly those with low incidence of gastric adenocarcinoma. The aim of this study was to evaluate endoscopic recognition and adequacy of surveillance for GIM and GA.

Methods We retrospectively analyzed patients diagnosed with GIM or GA in two academic centers in The Netherlands and UK between 2012 till 2019. Cases with GIM/GA diagnosis at index endoscopy were retrieved through systematic search of pathology databases using ‘gastric’ and ‘intestinal metaplasia’ or ‘atrophy’ keywords. Endoscopy reports were analyzed to ascertain endoscopic diagnoses. Adequacy of surveillance was assessed based on ESGE guidelines published in 2012 at the index endoscopy. Criteria include: GA/GIM of the proximal stomach, any location of GA/GIM with a positive family history for gastric cancer or persistent Helicobacter pylori infection. Surveillance was also adequate if patients were discharged if pan-gastric sampling showed only GA/GIM of the distal stomach without risk factors or when age was above 75 years.

Results We included 319 patients with a median follow-up of 53 months. Patient characteristics are shown in [table 1]. Endoscopic recognition rates were 61,1 % for GA and 17,4 % for GIM. Surveillance was adequately carried out in 139 of 319 patients (43,6 %) . During follow-up two patients (0,6 %) developed gastric cancer after the detection of GIM, which gives an incidence of 0,14 per 100 patient years.

Tab. 1

Patient characteristics (N = 319)

Mean age (years)

66

Intestinal metaplasia

  • None

  • Proximal

  • Distal

  • Both locations

  • Present, location unknown

60 (19 %)

54 (17 %)

101 (32 %)

68 (21 %)

36 (11 %)

Only gastric atrophy

60 (19 %)

H.pylori present

48 (15 %)

Family history of gastric cancer

  • Yes

  • No

  • Unknown

14 (4 %)

156 (49 %)

149 (47 %)

Conclusions Adequate surveillance of GIM and GA according to current guidelines was under 50 % in two academic centers in countries with a low incidence of gastric cancer. The rate of endoscopic recognition of pre-cancerous lesions is low. The results of this study suggest that substantial improvement is required in adherence to guidelines for surveillance and endoscopic training in detection of pre-malignant conditions.

Citation: Honing J, Dieninyte E, O’Donovan M et al. eP69 SURVEILLANCE AND ENDOSCOPIC RECOGNITION OF GASTRIC INTESTINAL METAPLASIA AND ATROPHIC GASTRITIS: A RETROSPECTIVE COHORT STUDY IN TWO ACADEMIC CENTERS. Endoscopy 2021; 53: S118.



Publication History

Article published online:
19 March 2021

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