Kyoto classification risk scoring system and endoscopic grading of gastric intestinal metaplasia for gastric cancer: Multicenter observation study in Japan

Abstract

Objectives: The usefulness of endoscopic and histological risk assessment for gastric cancer (GC) has not been fully investigated in Japanese clinical practice. Methods:In this multicenter observation study, GC and non-GC patients were prospectively enrolled in 10 Japanese facilities. The Kyoto classification risk scoring system, the Kimura-Takemoto endoscopic atrophy classification, the endoscopic grading of gastric intestinal metaplasia (EGGIM), the operative link on gastritis assessment (OLGA) and the operative link on gastric intestinal metaplasia assessment (OLGIM) were applied to all patients. The strength of an association with GC risk was compared. In addition, important endoscopic findings in the Kyoto classification were identified.Results: Overall, 115 GC and 265 non-GC patients were analyzed. Each risk stratification method had a significant association with GC risk in univariate analysis. In multivariate analysis, OLGIM stage III/IV (odds ratio [OR] 2.8 [95% CI 1.5-5.3]), high EGGIM score (OR 1.8 [1.0-3.1]) and opened-type Kimura-Takemoto (OR 2.5 [1.4-4.5]) had significant associations with GC risk. In the Kyoto classification, opened-type endoscopic atrophy, invisible regular arrangement of collecting venules (RAC), extensive (>30%) intestinal metaplasia in the corpus in image-enhanced endoscopy, and map-like redness in the corpus were independent high-risk endoscopic findings. The modified Kyoto classification risk scoring system using these four findings demonstrated a better area under the receiver operating characteristic curve value (0.750, P = 0.052) than that of the original Kyoto classification (0.706). Conclusions:The OLGIM stage III/IV, high EGGIM score and open-typed Kimura-Takemoto had strong association with GC risk in Japanese patients. The modified Kyoto classification risk scoring system may be useful for GC risk assessment, which warrants further validation. (UMIN000027023).

Depictability of the upper gastrointestinal tract on forward‐viewing radial endoscopic ultrasonography versus standard upper esophagogastroduodenoscopy

“…This short scope position cannot always depict the frontal and inferior parts of the angulus. Invisible RAC in the angulus is one of the independent high‐risk endoscopic findings for gastric cancer 12 . In our study, the frontal part of lesser curvature in angulus was not depicted on forward‐viewing radial EUS in half of the patients with chronic gastritis.…”

Response to letter regarding: development of plasma ghrelin level as a novel marker for gastric mucosal atrophy after Helicobacter pylori eradication

“…However, the OLGIM has already been shown to be useful in assessing the risk of gastric cancer [ 5 ] and even taking into account the uncertainty of the point biopsy, it can be inferred that the OLGIM reflects the loss of oxyntic glands. Moreover, it has been proven that the OLGIM stage III/IV and open-typed atrophic gastritis (Kimura-Takemoto) had a strong association [ 6 ]. Although the true association with the loss of oxyntic glands is not known, it is at least a useful finding that plasma ghrelin levels in our study are associated with both endoscopic gastritis and the extent of histological intestinal metaplasia by OLGIM.…”

Current status of noninvasive endoscopic assessment of gastric cancer risk and future perspective

“…It scores gastric atrophy according to the Kimura–Takemoto classification, and intestinal metaplasia by white light imaging, fold enlargement, nodularity, diffuse redness, and invisibility of regular arrangement of collecting venules (RAC) in the angulus. Recently, Kawamura et al 1 . adjusted the weighting of important findings of the Kyoto classification system to be more suitable for the evaluation of gastric cancer risk.…”

“…It scores gastric atrophy according to the Kimura-Takemoto classification, and intestinal metaplasia by white light imaging, fold enlargement, nodularity, diffuse redness, and invisibility of regular arrangement of collecting venules (RAC) in the angulus. Recently, Kawamura et al 1 adjusted the weighting of important findings of the Kyoto classification system to be more suitable for the evaluation of gastric cancer risk. Using this modified Kyoto classification, gastric atrophy is scored according to the Kimura-Takemoto classification, and intestinal metaplasia is scored by IEE, invisibility of RAC in the angulus, and extent of map-like redness.…”

“…On the contrary, recent advances in endoscopy have enabled more precise mucosal inspection, and image-enhanced endoscopy (IEE) has enabled the identification of atrophy and intestinal metaplasia of the gastric mucosa without performing "invasive" biopsy. Currently, stratification of gastric cancer risk by endoscopic findings is the best method and the "modified Kyoto classification" proposed by Kawamura et al 1 will be one of the useful methods to predict gastric cancer risk. In the future, prediction of gastric cancer risk using a quantitative and less invasive method without endoscopy will be needed.…”