scholarly journals The Distribution of Incomplete Gastric Intestinal Metaplasia (GIM) Subtype among Biopsy Sites according to the Updated Sydney System and Its Association with GIM Extension

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Duc Trong Quach ◽  
Huy Minh Le ◽  
Trung Sao Nguyen ◽  
Toru Hiyama
Keyword(s):  
High Risk ◽  
Intestinal Metaplasia ◽  
Periodic Acid ◽  
Risk Marker ◽  
Gastric Intestinal Metaplasia ◽  
Biopsy Specimens ◽  
Sydney System ◽  
Updated Sydney System ◽  
Greater Curvature ◽  
Lesser Curvature

Background. Current guidelines recommend that extensive gastric intestinal metaplasia (GIM) be considered as a high-risk marker for the development of gastric cancer (GC). But there is emerging evidence that the incomplete GIM subtype is also a high-risk marker. Aims. To evaluate the performance of biopsy sites according to the updated Sydney system on detecting the incomplete GIM subtype and to assess its association with GIM extension. Patients and methods. A cross-sectional study was conducted on 280 Vietnamese patients with nonulcer dyspepsia. Biopsy specimens were taken from gastric sites according to the updated Sydney system, and sections were routinely stained with Giemsa and hematoxylin and eosin. Biopsy specimens with intestinalization were further evaluated for GIM subtypes with alcian blue 2.5 and periodic acid Schiff stainings. Two experienced pathologists jointly examined all the specimens and reached consensus. Results. The rates of patients with GIM and the incomplete GIM subtype were 81 (28.9%) and 24 (8.4%), respectively. There was no GIM in specimens taken from the greater curvature of corpus. The proportions of the incomplete GIM subtype detected at the incisura angularis, lesser curvature of corpus, lesser curvature of antrum, and greater curvature of antrum were 34.3% (12/35), 34.5% (10/29), 40.5% (17/42), and 31.6 (6/19), respectively, which were not significantly different (p=0.89). The presence of an incomplete GIM subtype was associated with multifocal GIM (i.e., ≥3 out of 5 biopsy sites with GIM) (OR=4.02, CI 95%, 1.33–12.16, p=0.022) and extensive GIM (i.e., GIM in specimens from both of corpus and antrum) (OR=2.89, CI 95% 1.04–8.02, p=0.045). Conclusions. The proportions of an incomplete GIM subtype were not significantly different among gastric biopsy sites with intestinalization. The association between an incomplete GIM subtype and GIM extension, therefore, may be due to an sum accumulation effect.

scholarly journals Distribución de estadios de OLGA y OLGIM según edad y estado del Helicobacter pylori en un hospital público nivel III en Lima, Perú

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Andrea Carlin Ronquillo ◽  
Alex Ventura León ◽  
Jorge L Espinoza Ríos ◽  
Eduar A Bravo Paredes ◽  
Paúl Gómez Hinojosa ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
High Risk ◽  
Upper Gastrointestinal Endoscopy ◽  
Gastric Intestinal Metaplasia ◽  
Endoscopic Control ◽  
Staging Systems ◽  
Sydney System ◽  
Group 5 ◽  
Updated Sydney System ◽  
H Pylori

Introduction. The operative link for gastritis assessment (OLGA) and the operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems have been suggested to provide risk of assessment for gastric cancer. Objective. To evaluate the distribution of OLGA and OLGIM staging by age and Helicobacter pylori status. Material and methods. We studied 197 subjects undergoing elective upper gastrointestinal endoscopy. The presence of the H. pylori and histological changes were evaluated using the updated Sydney system. Stages III and IV of OLGA/OLGIM were considered high risk stages. Results. The H. pylori rate was 56.85% (112/197). High-risk OLGA/OLGIM cases were rare: 7/112 (6.5%) cases of OLGA in the H. pylori positive group and 6/85 (7%) in the H. pylori negative group; 5 (4.4%) cases of OLGIM in the H. pylori positive and 6 (7%) in the H. pylori negative. The proportion of advanced stages of OLGA and OLGIM increased with age (p < 0.001). High-risk OLGA was not found before age 40 regardless of the presence of H. pylori, but increased to 16.2%, 10.3%, 17.3% and 40.8% in subjects in the fourth, fifth, sixth and seventh decade of life respectively. The OLGIM high risk showed a similar trend: 0% before 40 years and up to 22.6% in people of 70 years. Conclusions. High-risk OLGA/OLGIM cases are infrequent before age 40 and increase significantly with age. No relation was found with the presence of the H. pylori. According to these protocols, only a fifth of the patients would strictly require endoscopic control.

scholarly journals Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study

Endoscopy ◽  
2018 ◽  
Vol 51 (06) ◽  
pp. 515-521 ◽  
Author(s):  
Gianluca Esposito ◽  
Pedro Pimentel-Nunes ◽  
Stefano Angeletti ◽  
Rui Castro ◽  
Diogo Libânio ◽  
...  
Keyword(s):  
Intestinal Metaplasia ◽  
Narrow Band Imaging ◽  
Positive Likelihood Ratio ◽  
Gastric Intestinal Metaplasia ◽  
Sydney System ◽  
Greater Curvature ◽  
Sensitivity Specificity ◽  
First Time ◽  
Targeted Biopsies

Abstract Background Random biopsies are recommended to identify individuals at risk of gastric adenocarcinoma. Cumulative evidence suggests that narrow-band imaging (NBI) can be used to grade gastric intestinal metaplasia (GIM). We aimed to externally validate a classification of endoscopic grading of gastric intestinal metaplasia (EGGIM). Methods Consecutive patients in two centers were submitted to high resolution white-light gastroscopy followed by NBI to estimate EGGIM – a score (0 – 10) resulting from the sum of endoscopic assessments of GIM, scored as 0, 1, or 2 for no GIM, ≤ 30 %, or > 30 % of the mucosa, respectively, in five areas (lesser and greater curvature of both antrum and corpus, and incisura). If GIM was endoscopically suspected, targeted biopsies were performed; if GIM was not noticeable, random biopsies were performed according to the Sydney system to estimate the operative link on gastric intestinal metaplasia (OLGIM; the gold standard). Results 250 patients (62 % female; median age 55 years) were included. GIM was staged as OLGIM 0, I, II, III, IV in 136 (54 %), 15 (6 %), 52 (21 %), 34 (14 %), and 13 (5 %) patients, respectively. All patients with GIM except three were identifiable with targeted biopsies. For the diagnosis of OLGIM III/IV, the area under the ROC curve was 0.96 (95 % confidence interval [CI] 0.93 – 0.98) and by using the cutoff > 4, sensitivity, specificity, and positive likelihood ratio were 89 %, 95 %, and 16.5, respectively; results were similar (91 %, 95 %, and 18.1) when excluding patients with foveolar hyperplasia. Conclusions For the first time, an endoscopic approach was externally validated to determine the risk of gastric cancer without the need for biopsies. This can be used to simplify and individualize the management of patients with gastric precancerous conditions.

scholarly journals Biopsy strategies for endoscopic screening of pre-malignant gastric lesions

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Meng Zhang ◽  
Shan Liu ◽  
Yue Hu ◽  
Hai-biao Bao ◽  
Li-na Meng ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Intestinal Metaplasia ◽  
Staging System ◽  
Youden Index ◽  
Kendall’S Tau ◽  
Endoscopic Screening ◽  
Kendall's Tau ◽  
Gastric Intestinal Metaplasia ◽  
Mild Degree ◽  
Lesser Curvature

Abstract Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) were adopted to evaluate gastric risk stratification in five biopsy samples. This study aimed to evaluate the degree of gastric atrophy (GA) and intestinal metaplasia (IM) in five locations to detect a more representative biopsy sample in gastric cancer (GC) screening. Our study enrolled 368 patients and 5 biopsy pieces were acquired from them. Gastric risk stratification was calculated by OLGA and OLGIM staging system. The results revealed that the IM score in the incisura angularis was higher than that in the larger and lesser curvature of corpus mucosa (p = 0.037 and p = 0.030, respectively) and the IM score in the lesser curvature of antrum mucosa was higher than that in the incisura angularis mucosa (p = 0.018). IM is more frequently observed in the angulus region than in the lesser curvature of corpus in the mild degree (p = 0.004) and mild IM lesions in the lesser curvature of antrum were more frequently observed than in the incisura angularis mucosa (p = 0.004), Four biopsy pieces protocol (larger curvature and lesser curvature of the antrum, lesser curvature of the corpus and angulus) demonstrated accurate consistency (97.83% and 98.37%, respectively) with a Kendall’s tau-b of higher than 0.990, along with low misdiagnosis rates of OLGA and OLGIM (III + IV) (9.76% and 5.00%, respectively). Three biopsy pieces protocol (lesser curvature of the antrum and corpus, angulus biopsy) in OLGA and OLGIM staging system was close to the standard protocol (five biopsy specimens) with a consistency of 94.84% and 94.29% and has a Kendall’s tau-b higher than 0.950 and diagnostic omission rates of 9.76% and 5.00%, respectively, which was exactly the same with the four biopsy pieces protocol. Furthermore, it had the second-highest Youden index (0.902 and 0.950, respectively) and area under the ROC curve (0.992 and 0.996, respectively) for the screening of high-risk GC by OLGA and OLGIM stages. Thus, we recommended the angulus and the lesser curvature of antrum as a conventional biopsy and three biopsy pieces for further GC risk screening.

scholarly journals Su1250 – Feasibility of Gastric Intestinal Metaplasia Surveillance in a High Risk American Cohort

2019 ◽  
Vol 156 (6) ◽  
pp. S-519
Author(s):  
Alice A. Lee ◽  
Jeffrey Yeh ◽  
Christopher Ko ◽  
Liam Hilson ◽  
Brent Hiramoto ◽  
...  
Keyword(s):  
High Risk ◽  
Intestinal Metaplasia ◽  
Gastric Intestinal Metaplasia

scholarly journals Interobserver agreement of estimating the extent of intestinal metaplasia in patients with chronic atrophic gastritis

2021 ◽  
Author(s):  
Julia M. Lerch ◽  
Rish K. Pai ◽  
Ian Brown ◽  
Anthony J. Gill ◽  
Dhanpat Jain ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Interobserver Agreement ◽  
Periodic Acid ◽  
Intraclass Correlation ◽  
Chronic Atrophic Gastritis ◽  
Periodic Acid Schiff ◽  
Gastric Intestinal Metaplasia ◽  
Metaplastic Epithelium

AbstractThe extent of gastric intestinal metaplasia (GIM) can be used to determine the risk of gastric cancer. Eleven international gastrointestinal expert pathologists estimated the extent of GIM on haematoxylin and eosin (H&E)- and Alcian blue-Periodic acid Schiff (AB-PAS)-stained slides of 46 antrum biopsies in 5% increments. Interobserver agreement was tested with the intraclass correlation coefficient (ICC). Correlation between standard deviation and extent of GIM was evaluated with the Spearman correlation. The interobserver agreement was very good (ICC = 0.983, 95% confidence interval (CI) 0.975–0.990). The use of AB-PAS did not increase the agreement (ICC = 0.975, 95% CI 0.961–0.985). Cases with a higher amount of metaplastic epithelium demonstrated a higher standard deviation (rs = 0.644; p < 0.01), suggesting lower diagnostic accuracy in cases with extensive GIM. In conclusion, estimating the extent of GIM on H&E-stained slides in patients with chronic atrophic gastritis can be achieved satisfactorily with high interobserver agreement, at least among international expert gastrointestinal pathologists.

Serum pepsinogen levels and OLGA/OLGIM staging in the assessment of atrophic gastritis types

2020 ◽  
pp. postgradmedj-2020-139183
Author(s):  
Deniz Ogutmen Koc ◽  
Sibel Bektas
Keyword(s):  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Disease Stage ◽  
Low Grade ◽  
Serum Pepsinogen ◽  
Gastric Intestinal Metaplasia ◽  
Biopsy Specimens ◽  
Staging Systems ◽  
Advanced Stages ◽  
Autoimmune Atrophic Gastritis

BackgroundWe assessed the validity of using serum pepsinogen tests (sPGTs) to differentiate autoimmune atrophic gastritis (AAG) from environmental atrophic gastritis (EAG). We also investigated the correlation and prognostic value between disease stage, according to Operative Link for Gastritis Assessment (OLGA)/Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM), and sPGT results in patients with gastric atrophy.MethodsWe enroled 115 patients in this prospective study: 95 with atrophic gastritis (16 with AAG and 79 with EAG) and 20 non-atrophic gastritis. These patients, along with 32 control patients, underwent esophagogastroduodenoscopy. Atrophy and intestinal metaplasia of the gastric biopsy specimens were staged according to the OLGA/OLGIM staging systems.ResultsThe median (IQR) age of the patients (83 females (56.5%)) was 58 (46–67) years. Patients in the AAG group represented histologically advanced stages. The AAG group had lower pepsinogen (PG) I and II levels, as well as a lower PGI/PGII ratio, compared with the EAG group (p<0.01, p<0.05 and p<0.01, respectively). The optimal PGI/PGII ratio for predicting AAG was ≤1.9 (100% sensitivity and 100% specificity), and that for predicting EAG was ≤9.2 (47.5% sensitivity and 90.6% specificity). The OLGA/OLGIM stage was negatively correlated with the PGI level and PGI/PGII ratio. In the AAG group, four of five patients with low-grade dysplasia had OLGA/OLGIM stage III–IV disease.ConclusionssPGT may provide valuable information for differentiating advanced-stage AAG from EAG, and in patients with atrophic gastritis, use of sPGTs and OLGA/OLGIM staging together may predict gastric cancer risk.

Different Pattern of Inflammatory and Atrophic Changes in the Gastric Mucosa of the Greater and Lesser Curvature

2015 ◽  
Vol 24 (4) ◽  
pp. 429-434
Author(s):  
Sergejs Isajevs ◽  
Inta Liepniece-Karele ◽  
Darja Svirina ◽  
Daiga Santare ◽  
Sandris Kaidaks ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Inflammatory Cells ◽  
Clinical Settings ◽  
Curvature Analysis ◽  
Biopsy Specimens ◽  
Greater Curvature ◽  
H Pylori ◽  
Lesser Curvature ◽  
Inflammatory Changes

Background & Aims: Appropriate biopsy sampling is important for the classification of gastritis, yet the extent of inflammation and atrophy of different regions of the stomach with chronic gastritis have been addressed only in a few studies. The aim of our study was to analyze the inflammatory, atrophic and metaplastic changes in the greater and lesser curvature of the antrum and corpus mucosa. Methods: 420 patients undergoing upper endoscopy were enrolled in the study. Four expert gastrointestinal pathologists graded biopsy specimens according to the updated Sydney classification. Results: The obtained results showed that the mononuclear and granulocyte inflammatory cells were more prominent in the corpus lesser curvature compared to the corpus greater curvature (p=0.01 and p=0.0001, respectively). In addition, the extent and degree of atrophy and intestinal metaplasia were more prominent in the corpus lesser compared to the greater curvature (p=0.002 and p=0.0065, respectively). The frequency of distribution of H. pylori did not differ throughout both the corpus and antrum greater and lesser curvature. However, the degree of H. pylori colonization in the corpus was higher in the lesser than in the greater curvature. The interobserver agreement was significantly higher for corpus atrophy compared to antrum atrophy.Conclusions: These findings demonstrated that the more severe atrophic, metaplastic and inflammatory changes were observed in the lesser compared to the greater curvature of the stomach. In routine clinical settings, corpus and antral biopsies should be obtained from both lesser and greater curvature. Analysis of the incisura biopsy is also important.  

Clue of Diagnosis for Autoimmune Gastritis

Digestion ◽  
2021 ◽  
pp. 1-8
Author(s):  
Toshihiro Nishizawa ◽  
Shuntaro Yoshida ◽  
Hidenobu Watanabe ◽  
Akira Toyoshima ◽  
Yosuke Kataoka ◽  
...  
Keyword(s):  
Detection Rate ◽  
Pathological Diagnosis ◽  
Autoimmune Gastritis ◽  
Detection Rates ◽  
Pathological Evaluation ◽  
Sydney System ◽  
Updated Sydney System ◽  
Greater Curvature ◽  
H Pylori ◽  
Parietal Cell Antibody

<b><i>Background:</i></b> The diagnostic clues for autoimmune gastritis (AIG) can be classified into 2 categories: endoscopic findings and pathological diagnosis. We believe that research on the AIG detection rate by endoscopists could provide a better understanding of the diagnosis of AIG. This study aimed to clarify the ratio of the endoscopic and the pathological diagnoses of AIG. <b><i>Methods:</i></b> We retrospectively reviewed consecutive patients who underwent esophagogastroduodenoscopy (EGD). During their first EGD, the gastric mucosa with C2 atrophy or more was biopsied for pathological evaluation based on the updated Sydney system. A gastric biopsy was also performed after <i>Helicobacter pylori</i> eradication, obtaining specimens from at least 2 sites, the greater curvature of the corpus and the antrum. We enrolled patients who were positive for the anti-parietal cell antibody and were diagnosed with AIG, histologically and/or endoscopically. The detection rates of AIG were compared between endoscopic diagnosis and pathological diagnosis. <b><i>Results:</i></b> A total of 10,822 patients underwent EGD during the study period. Finally, 41 patients with AIG were enrolled, leading to an AIG prevalence of 0.38% in this study. As for the clue leading to AIG detection, 31.7% (13/41) were diagnosed through endoscopy (proximal-predominant atrophy), and 68.3% (28/41) were diagnosed pathologically. The AIG detection rate by endoscopists in the posteradication group was significantly lower than in <i>the H. pylori-negative</i> group (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> Endoscopists frequently overlooked AIG, especially in posteradication cases. Pathological assessment using the updated Sydney system after <i>H. pylori</i> eradication might be a promising strategy to detect AIG better.

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