Please use this identifier to cite or link to this item: https://doi.org/10.1136/gutjnl-2021-324057
Title: Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP).
Authors: Lee, Jonathan WJ
ZHU FENG 
Supriya Srivastava 
Tsao, Stephen Kk
Khor, Christopher
HO KHEK YU 
Fock, Kwong Ming
Lim, Wee Chian
Ang, Tiing Leong
Chow, Wan Cheng
SO BOK YAN,JIMMY 
Koh, Calvin J
CHUA SHIJIA JOY 
Wong, Andrew SY
Rao, Jaideepraj
Lim, Lee Guan
Ling, Khoon Lin
Chia, Chung-King
Ooi, Choon Jin
Rajnakova, Andrea
Yap, Wai Ming
Salto-Tellez, Manuel
Ho, Bow
RICHIE CHUAN TECK SOONG 
CHIA KEE SENG 
TEO YIK YING 
Ming, Teh
YEOH KHAY GUAN 
Keywords: gastric cancer
pre-malignancy - GI tract
surveillance
Issue Date: 17-May-2021
Publisher: BMJ
Citation: Lee, Jonathan WJ, ZHU FENG, Supriya Srivastava, Tsao, Stephen Kk, Khor, Christopher, HO KHEK YU, Fock, Kwong Ming, Lim, Wee Chian, Ang, Tiing Leong, Chow, Wan Cheng, SO BOK YAN,JIMMY, Koh, Calvin J, CHUA SHIJIA JOY, Wong, Andrew SY, Rao, Jaideepraj, Lim, Lee Guan, Ling, Khoon Lin, Chia, Chung-King, Ooi, Choon Jin, Rajnakova, Andrea, Yap, Wai Ming, Salto-Tellez, Manuel, Ho, Bow, RICHIE CHUAN TECK SOONG, CHIA KEE SENG, TEO YIK YING, Ming, Teh, YEOH KHAY GUAN (2021-05-17). Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP).. Gut. ScholarBank@NUS Repository. https://doi.org/10.1136/gutjnl-2021-324057
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 H. pylori. 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.
Source Title: Gut
URI: https://scholarbank.nus.edu.sg/handle/10635/191323
ISSN: 0017-5749
1468-3288
DOI: 10.1136/gutjnl-2021-324057
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