How Do We Manage Gastric Intestinal Metaplasia? A Survey of Clinical Practice Trends for Gastrointestinal Endoscopists in the United States

Vance, Ralph B.; Kubiliun, Nisa; Dunbar, Kerry B.

doi:10.1007/s10620-016-4107-4

Cited by 19 publications

(21 citation statements)

References 25 publications

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“…Importantly, 97% of respondents felt that societal guidelines for management of premalignant gastric lesions would be beneficial to clinical practice[ 39 ]. These results were further supported by a study by Vance et al[ 40 ] that showed “variability in the knowledge and practice patterns of United States endoscopists related to surveillance of gastric intestinal metaplasia”.…”

Section: Discussionsupporting

confidence: 66%

Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia

Gomez

Patrie

Bleibel

et al. 2017

WJGE

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AIMTo determine which clinical factors might be associated with gastric intestinal metaplasia (IM) in a North American population.METHODSPathology and endoscopy databases at an academic medical center were reviewed to identify patients with and without gastric IM on biopsies for a retrospective cohort study. Patient demographics, insurance status, and other clinical factors were reviewed.RESULTSFour hundred and sixty-eight patients with gastric IM (mean age: 61.0 years ± 14.4 years, 55.5% female) and 171 without gastric IM (mean age: 48.8 years ± 20.8 years, 55.0% female) were compared. The endoscopic appearance of atrophic gastritis correlated with finding gastric IM on histopathology (OR = 2.05, P = 0.051). Gastric IM was associated with histologic findings of chronic gastritis (OR = 2.56, P < 0.001), gastric ulcer (OR = 6.97, P = 0.015), gastric dysplasia (OR = 6.11, P = 0.038), and gastric cancer (OR = 6.53, P = 0.027). Histologic findings of Barrett’s esophagus (OR = 0.28, P = 0.003) and esophageal dysplasia (OR = 0.11, P = 0.014) were inversely associated with gastric IM. Tobacco use (OR = 1.73, P = 0.005) was associated with gastric IM.CONCLUSIONPatients who smoke or have the endoscopic finding of atrophic gastritis are more likely to have gastric IM and should have screening gastric biopsies during esophagogastroduodenoscopy (EGD). Patients with gastric IM are at increased risk for having gastric dysplasia and cancer, and surveillance EGD with gastric biopsies in these patients might be reasonable.

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Section: Discussionsupporting

confidence: 66%

Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia

Gomez

Patrie

Bleibel

et al. 2017

WJGE

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“…Similarly, the biopsy protocol performed during endoscopies was heterogeneous (in number and site), and did not always follow the current recommendations that indicate that at least 2 antral and 2 corpus biopsies should be obtained. Other studies have also reported a low adherence to the guidelines [23], and one study performed in the United States showed that 75% of gastroenterologists were even not aware of the existence of guidelines for the surveillance and management of IM [24].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Characteristics and Endoscopic Management of Gastric Premalignant Lesions in France

Chapelle

Péron

Mosnier

et al. 2019

Dig Dis

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Introduction: Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. Design: All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). Results: Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. Conclusion: In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.

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“…5 Surveys of US endoscopists have found wide variation in practice patterns in the management of GIM, even among physicians regularly caring for populations that could be at increased risk based on race/ethnicity and/or immigration status. 8 An evidencebased guideline supported by a comprehensive literature review for management of patients with GIM has not been previously published in the United States. Accordingly, we aimed to develop evidence-based guidelines to inform management of patients with GIM incidentally detected on gastric biopsies in routine clinical practice.…”

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confidence: 99%

AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia

et al. 2020

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This guideline focuses on recommendations for management of patients with GIM detected as part of routine upper endoscopy for reasons including workup of endoscopically identified gastropathy/presumed gastritis, dyspepsia, or exclusion of H pylori. Screening for gastric cancer (either population-wide or in select populations) and management of patients with dysplasia of the gastric mucosa, gastric adenocarcinoma, and/or autoimmune gastritis are beyond the scope of the current guideline. This guideline is intended to aid decision-making for patients who are undergoing upper endoscopy in North America. GIM is See editorial on page 473.

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How Do We Manage Gastric Intestinal Metaplasia? A Survey of Clinical Practice Trends for Gastrointestinal Endoscopists in the United States

Cited by 19 publications

References 25 publications

Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia

Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia

Prevalence, Characteristics and Endoscopic Management of Gastric Premalignant Lesions in France

AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia

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