An international survey on recognition and characterization of atrophic gastritis and intestinal metaplasia

Hon Chi Yip; Noriya Uedo; Shannon M Chan; Anthony Yuen Bun Teoh; Simon Kin Hung Wong; Philip W Chiu; Enders Kwok Wai Ng

doi:10.1055/a-1230-3586

An international survey on recognition and characterization of atrophic gastritis and intestinal metaplasia

Endosc Int Open. 2020 Oct;8(10):E1365-E1370. doi: 10.1055/a-1230-3586. Epub 2020 Sep 22.

Authors

Hon Chi Yip¹, Noriya Uedo², Shannon M Chan¹, Anthony Yuen Bun Teoh¹, Simon Kin Hung Wong¹, Philip W Chiu¹, Enders Kwok Wai Ng¹

Affiliations

¹ Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong.
² Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

Abstract

Background and study aims Atrophic gastritis (AG) and intestinal metaplasia (IM) are premalignant conditions of gastric cancer and endoscopic recognition and characterization may help in stratifying the gastric cancer risk for screening and surveillance. However, there is currently lack of consensus in defining the severity of AG and IM. We aimed to conduct an international survey to understand the current practice of endoscopists worldwide. Methods An online survey was designed to collect data regarding participants' practice in endoscopic assessment of AG & IM. A test using images was conducted to evaluate the difference in accuracy of characterization of AG & IM. Results From July to October 2017, 249 endoscopists responded to the survey. Around 70 % of participants received some form of training on recognition of AG & IM. There was significant variety in the training received across different continents. One hundred seventy-six participants (70 %) would document the presence of both AG and IM, but the classification systems used were inconsistent between endoscopists. Overall accuracy in diagnosis of AG & IM in the image test was 84.5 % and 80.7 % respectively. The diagnostic accuracy was significantly higher among Japanese and Korean endoscopists compared to the rest of the world. Conclusion Training regarding endoscopic recognition of AG & IM differs significantly in different parts of the world. The difference in diagnostic accuracy for these premalignant gastric conditions may also explain the discrepancy in the early cancer detection rates among different countries. A simple unified classification system may be beneficial for better stratification of cancer risks.

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