Endoscopic and histological risk stratification for gastric cancer using gastric intestinal metaplasia

Background and Aim: Intestinal metaplasia (IM) of the gastric mucosa is strongly associated with the risk of gastric cancer (GC). This study was performed to investigate the usefulness of endoscopic and histological risk stratification for GC using IM. Methods: This was a post-hoc analysis of a multicenter prospective study involving 10 Japanese facilities (UMINCTR000027023). The ridge/tubulovillous pattern, light blue crest (LBC), white opaque substance (WOS), endoscopic grading of gastric IM (EGGIM) score using non-magnifying image-enhanced endoscopy, and operative link on gastric IM assessment (OLGIM) were evaluated for their associations with GC risk in all patients. Results: In total, 380 patients (115 with GC and 265 without GC) were analyzed. The presence of an LBC (limited to antrum: odds ratio [OR] 2.4 [95% confidence interval 1.1–5.0], extended to corpus: OR 3.6 [2.1–6.3]), the presence of WOS (limited to antrum: OR 3.0 [1.7–5.3], extended to corpus: OR 4.2 [2.1–8.2]), and histological IM (limited to antrum: OR 3.2 [1.4–7.4], extended to corpus: OR 8.5 [4.5–16.0]) were significantly associated with GC risk. Additionally, the EGGIM score (5–8 points: OR 8.8 [4.4–16.0]) and OLGIM (stage III/IV: OR 12.5 [6.1–25.8]) were useful for stratification of GC risk. The area under the receiver operating characteristic curve value for GC risk was 0.740 for OLGIM and 0.706 for EGGIM. Conclusions: The LBC, WOS, EGGIM, and OLGIM were strongly associated with GC risk in Japanese patients. This finding can be useful for GC risk assessment in daily clinical practice.