Article Synopsis
- The study aimed to assess how gastric intestinal metaplasia (IM) contributes to the development of gastric cancer (GC) and to validate a surveillance method called the Operative Link on Gastric Intestinal Metaplasia (OLGIM) in regions with lower GC rates.
- A longitudinal study involving 2980 patients in Singapore found that those with more advanced OLGIM stages had a significantly higher risk of developing early gastric neoplasia (EGN), with serious cases appearing within a short timeframe after diagnosis.
- The researchers recommend a risk-based monitoring strategy, suggesting more frequent endoscopic surveillance for high-risk patients (OLGIM stages III-IV) compared to those with intermediate risk (OLGIM II).
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Article Abstract
Objective: To investigate the incidence of gastric cancer (GC) attributed to gastric intestinal metaplasia (IM), and validate the Operative Link on Gastric Intestinal Metaplasia (OLGIM) for targeted endoscopic surveillance in regions with low-intermediate incidence of GC.
Methods: A prospective, longitudinal and multicentre study was carried out in Singapore. The study participants comprised 2980 patients undergoing screening gastroscopy with standardised gastric mucosal sampling, from January 2004 and December 2010, with scheduled surveillance endoscopies at year 3 and 5. Participants were also matched against the National Registry of Diseases Office for missed diagnoses of early gastric neoplasia (EGN).
Results: There were 21 participants diagnosed with EGN. IM was a significant risk factor for EGN (adjusted-HR 5.36; 95% CI 1.51 to 19.0; p<0.01). The age-adjusted EGN incidence rates for patients with and without IM were 133.9 and 12.5 per 100 000 person-years. Participants with OLGIM stages III-IV were at greatest risk (adjusted-HR 20.7; 95% CI 5.04 to 85.6; p<0.01). More than half of the EGNs (n=4/7) attributed to baseline OLGIM III-IV developed within 2 years (range: 12.7-44.8 months). Serum trefoil factor 3 distinguishes (Area Under the Receiver Operating Characteristics 0.749) patients with OLGIM III-IV if they are negative for . Participants with OLGIM II were also at significant risk of EGN (adjusted-HR 7.34; 95% CI 1.60 to 33.7; p=0.02). A significant smoking history further increases the risk of EGN among patients with OLGIM stages II-IV.
Conclusions: We suggest a risk-stratified approach and recommend that high-risk patients (OLGIM III-IV) have endoscopic surveillance in 2 years, intermediate-risk patients (OLGIM II) in 5 years.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995828 | PMC |
| http://dx.doi.org/10.1136/gutjnl-2021-324057 | DOI Listing |
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