Endoscopy 2018; 50(04): S75
DOI: 10.1055/s-0038-1637250
ESGE Days 2018 oral presentations
21.04.2018 – Stomach: Improving diagnosis
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC GRADING FOR GASTRIC INTESTINAL METAPLASIA (EGGIM): A MULTICENTRE VALIDATION STUDY

G Esposito
1   University Sapienza, Department of Medical-surgical Sciences and Translational Medicine, Rome, Italy
,
P Pimentel-Nunes
2   Portuguese Oncology Institute of Porto, Gastroenterology Department, Porto, Portugal
,
S Angeletti
1   University Sapienza, Department of Medical-surgical Sciences and Translational Medicine, Rome, Italy
,
R Castro
2   Portuguese Oncology Institute of Porto, Gastroenterology Department, Porto, Portugal
,
D Libânio
2   Portuguese Oncology Institute of Porto, Gastroenterology Department, Porto, Portugal
,
G Galli
1   University Sapienza, Department of Medical-surgical Sciences and Translational Medicine, Rome, Italy
,
E Lahner
1   University Sapienza, Department of Medical-surgical Sciences and Translational Medicine, Rome, Italy
,
E Di Giulio
1   University Sapienza, Department of Medical-surgical Sciences and Translational Medicine, Rome, Italy
,
B Annibale
1   University Sapienza, Department of Medical-surgical Sciences and Translational Medicine, Rome, Italy
,
M Dinis-Ribeiro
2   Portuguese Oncology Institute of Porto, Gastroenterology Department, Porto, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

    Aims:

    To determine the accuracy of Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) compared with histological assessment of intestinal metaplasia (IM).

    Methods:

    Consecutive adult patients (n = 250) in 2 centers (female 62%; age 55 (20 – 89) years), were submitted to upper GI endoscopy using High-Resolution White Light (HR-WLE) followed by HR narrow band imaging (HR-NBI) to estimate EGGIM (0 – 10 points). This score is estimated by the sum of estimates of IM (0, 1 or 2 if no IM, ≤30% or > 30% respectively) in 5 different areas (lesser and greater curvature in both antrum and corpus and incisura). If IM was endoscopically suspected, targeted biopsies were performed; if no IM was noticeable, random according to Sydney-Houston system were done. Histological assessment using OLGIM (gold-standard) was blinded to EGGIM.

    Results:

    IM was staged as OLGIM 0, 1, 2, 3 and 4 respectively: 136 (54%), 15 (6%), 52 (21%), 34 (14%) and 13 patients (5%). The overall severity staging accuracy of EGGIM compared to OLGIM was 87% (95% CI 75,6 – 99,1).

    Tab. 1:

    EGGIM scores compared to OLGIM

    EGGIM 0

    EGGIM 1 – 4

    EGGIM 5 – 10

    OLGIM 0

    125 (91.9)

    11 (8.1)

    0

    OLGIM I-II

    3 (4.5)

    53 (79.1)

    11 (16.4)

    OLGIM III-IV

    0

    5 (10.6)

    42 (89.4)

    Sensitivity for advance stages (III-IV) was 89% (95% CI 64,4 – 120,8) and a specificity for the absence of IM (0) of 92% (95% CI 76,5 – 109,5). Of patients in whom EGGIM and OLGIM were in disagreement, 9 were H. pylori positive; in 8 of these nine patients EGGIM score was overestimated compared to OLGIM.

    Conclusions:

    This is the first prospective assessment of EGGIM and it shows a high diagnostic performance compared to OLGIM. This approach could be used to simplify the surveillance of these patients by avoiding biopsies. A possible confounding factor leading to overestimation of presence of IM might be the presence of H. pylori infection.


    #