Original articleClinical endoscopyThe use of clinical, histologic, and serologic parameters to predict the intragastric extent of intestinal metaplasia: a recommendation for routine practice
Section snippets
Patient selection
Consecutive outpatients with a previous histologic confirmed diagnosis of IM of the gastric mucosa (index diagnosis) were invited to undergo a surveillance endoscopy between March 2006 and June 2007. The surveillance endoscopy was performed within 6 years after the initial diagnosis of IM. Patients with a previous diagnosis of upper-GI malignancy or a history of esophageal or gastric surgery were excluded. The institutional review boards of the participating hospitals approved this study, and
Results
In total, 88 patients (43 men, 45 women; mean age 60.4 years, range 24.0-75.9 years) underwent a surveillance endoscopy at a mean (SD) follow-up interval of 1.7 ± 1.5 years after initial diagnosis. Seventy-one patients (81%) were native Dutch and 17 (19%) were of non-Dutch origin. Previous peptic ulcer disease was reported in the medical records of 25 patients (28%), and H pylori eradication therapy was in the records of 36 patients (41%).
Discussion
This study clearly identifies a family history of gastric cancer, a pepsinogen I to II ratio <3.0, the presence of moderate or marked IM of the index biopsy specimen and alcohol use, with an average of at least 1 unit/d, as important predictive parameters for extensive IM at surveillance endoscopy. Our study adds to existing knowledge of risk factors for progression of premalignant gastric lesions to gastric cancer by combining these individual risk factors into a risk stratification rule that
Conclusion
Patients with extensive intragastric IM are at increased gastric cancer risk. However, the intragastric extent of IM is usually unknown at the time of diagnosis. In this study, we showed that a risk score of clinical, histologic, and serologic parameters can predict the presence of extensive intragastric IM and may serve as a tool to select patients for surveillance endoscopy in routine clinical practice.
Acknowledgments
The authors wish to thank R. J. Th. Ouwendijk, gastroenterologist, Ikazia Hospital, Rotterdam, and the Gastroenterology and Pathology Departments of Erasmus MC University Medical Center, Rotterdam, Rijnstate Hospital, Arnhem, Deventer Hospital, Deventer, and Medisch Centrum Rijnmond Zuid, Rotterdam, for providing their contribution to this study.
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Acetic acid chromoendoscopy for determining the extent of gastric intestinal metaplasia
2017, Gastrointestinal EndoscopyCitation Excerpt :Several less-invasive modalities that overcome the limitations of a biopsy-based approach are available. de Vries et al8 suggested a risk score comprising clinical, histologic, and serologic parameters to predict extensive gastric IM and reported that a score >4 was diagnostic for multifocal IM and severe IM with a sensitivity of 92% to 96%. Although this combined scoring system minimizes the number of biopsy punches required, an index biopsy specimen is required and the pepsinogen I/II ratio must be calculated, which are not usually performed in screening examinations in primary care clinics.
Tobacco smoking and intestinal metaplasia: Systematic review and meta-analysis
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2013, Best Practice and Research: Clinical GastroenterologyEfficacy of narrow-band imaging for detecting intestinal metaplasia in adult patients with symptoms of dyspepsia
2018, Revista de Gastroenterologia de Mexico
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 141.
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