Follow-up for Patients with Intestinal Metaplasia Restricted to the Antrum

English (OpenAlex)

Objective: Guidelines recommend endoscopic surveillance for patients with extensive atrophy/intestinal metaplasia (IM), but follow-up is not recommended for patients with atrophy/IM restricted to the antrum.We evaluated the risk of neoplastic lesions in patients with antrum-restricted IM to determine whether surveillance endoscopy is necessary.Methods: Overall, 117 patients with antrum-restricted IM diagnosed within the past 10 years underwent surveillance endoscopy.The gastric biopsy specimens were evaluated for atrophy, IM, and dysplasia.Results: We enrolled 117 patients.Surveillance endoscopy was performed at a median (interquartile range) of 7.2 years (5.9-8.7 years) after the initial diagnosis of IM.On surveillance endoscopy, 27.4% of patients exhibited progression in their IM grade, whereas 25.6% had atrophy progression, and 33.3% had dysplasia progression.High-grade dysplasia and gastric cancer (GC) were detected in four and two patients, respectively.The annual incidence of GC in patients with antrum-restricted IM was 0.17%.IM grade and type regressed in 29.9% and 38.5% of patients, respectively.Most patients with progressive IM grade, IM type, and dysplasia on surveillance endoscopy had Operative Link on Gastritis Assessment (OLGA) stage 3-4 (p=0.0001,p=0.008, and p=0.0001, respectively), and most patients with progressive atrophy and dysplasia had Operative Link on Gastric IM (OLGIM) stage 3-4 (both p=0.001). Conclusion:Patients with IM restricted to the antrum are at risk for neoplastic lesions and require endoscopic surveillance, contrary to existing recommendations.Premalignant lesions can exhibit both progression and regression.Therefore, a patient-specific surveillance program based on OLGA and OLGIM might be appropriate.