Endoscopic scoring system for gastric atrophy and intestinal metaplasia: correlation with OLGA and OLGIM staging: a single-center prospective pilot study in Korea

Abstract

Background/Aims

We aimed to develop an endoscopic scoring system to evaluate gastric atrophy and intestinal metaplasia using narrow-band imaging (NBI) and near focus mode (NFM) to compare endoscopic scores with the Operative link for gastritis assessment (OLGA) and the Operative link for gastric intestinal metaplasia assessment (OLGIM).

Methods

A total of 51 patients who underwent diagnostic esophagogastroduodenoscopy were prospectively enrolled and endoscopic scoring using NBI and NFM was performed. Four areas (the lesser and greater curvatures of the antrum and the lesser and greater curvature side of the corpus) were observed and biopsies were taken. The degree of atrophy was scored from 0 to 2 according to the Kimura-Takemoto classification. The degree of intestinal metaplasia was scored from 0 to 4 according to the location and the extent of the intestinal metaplasia.

Results

The correlation coefficient for atrophy between the endoscopic and histologic scores was 0.70 (95% CI: 0.52–0.81 p < .001) and for intestinal metaplasia, it was 0.75 (95% CI: 0.60–0.85; p < .001). For atrophic gastritis, an endoscopic score >1 correlated with OLGA stage III and IV with a sensitivity, specificity, positive predictive value, negative predictive value, and agreement of 88, 74, 75, 87, and 80.4%, respectively, and for intestinal metaplasia, an endoscopic score >1 correlated with high OLGIM stage III and IV with 100, 59, 69, 100, and 78.4%, respectively.

Conclusions

Endoscopic scoring for gastric atrophy and intestinal metaplasia using NBI-NFM likely correlates with histologic staging in Korea, a high-risk region for gastric cancer.

Keywords:

• Gastritis
• atrophy
• metaplasia
• endoscopy
• narrow-band imaging

Author contributions

This study was designed, directed, and coordinated by CKD, PYS, and NHK. CKD and NHK carried out recruitment of the patients and their endoscopies. A pathologic review was performed by PYS. KHJ performed the statistical analysis. CKD and NHK participated in data interpretation and drafted the manuscript. All authors reviewed the manuscript and approved the final version of the manuscript.

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

This study was supported by the Korean College of Helicobacter and an Upper Gastrointestinal Research Foundation grant.