Gastric cancer (GC) is the third leading cause of cancer mortality and the fifth for incidence worldwide. Metaplastic atrophic gastritis (MAG), which is the replacement of the oxyntic mucosa by pseudopyloric metaplasia (PPM), intestinal metaplasia (IM), or fibrosis, represents a precancerous condition on which GC could develop. Electronic chromoendoscopy (EC) is a technique that enhances the visualization of surface and vascular patterns and is able to diagnose IM and cancerous conditions with high accuracy, permitting to perform targeted biopsies instead of random biopsies. Recently, a new classification (Endoscopic grading of gastric intestinal metaplasia ¿ EGGIM) based on the diagnosis and staging of IM by the use of EC, was proposed and then validated. Regarding surveillance for MAG, evidence is scarce and the correct follow-up strategy is still debated.
This project is composed of 3 parts:
1.To investigate the role of PPM in the risk of GC and the use of EC for targeting biopsies to assess the correct biopsy protocol to diagnose this condition: a longitudinal cohort study conducted on patients with metaplastic and non-metaplastic atrophic gastritis with the use of EC and EGGIM classification for the diagnosis of PPM and the associated risk of GC.
2. To investigate the role of EC and, in particular, blue-light imaging (BLI) in the diagnosis and staging of IM using the EGGIM classification: a prospective study based on the comparison of BLI targeted biopsies versus the updated Sydney system protocol with traditional white light scopes with the use of EGGIM classification to stage the presence of IM and the risk of GC.
3. To define the most appropriate endoscopic follow-up for the different patients with gastric precancerous conditions considering clinical, endoscopic and histological aspects in a prospective randomized study where patients will be randomized to different endoscopic follow-up based on clinical, endoscopic and histological characteristics.
