Work

Endoscopic grading of gastric intestinal metaplasia and microvascular pattern for assessing gastric cancer risk: a prospective study

Year: 2026

Type: article

Abstract: Background and Aims The endoscopic grading of gastric intestinal metaplasia (EGGIM) has not been comprehensively validated. Microvascular (MV) pattern abnormalities are critical for diagnosing gastric neoplastic transformation. The present study aims to validate the diagnostic accuracy of EGGIM for identifying high-risk GIM patients and to develop a modified EGGIM model incorporating microvascular pattern, evaluating its diagnostic performance for risk stratification of GC development in GIM patients.Methods All patients underwent EGGIM scoring and microvascular pattern evaluation. Targeted or random biopsies were performed at the antrum, incisura, and corpus, followed by operative link on gastric intestinal metaplasia assessment (OLGIM). The sensitivity, specificity, positive likelihood ratios (PLR), and positive predictive values (PPV) of both EGGIM and the modified EGGIM model for assessing GC risk in GIM patients were validated.Results A total of 144 patients were enrolled. The area under curve (AUC) of the receiver operating characteristic of EGGIM for diagnosing OLGIM III-IV was 0.885 (95% CI 0.837–0.943). At the cutoff value ≥4, the sensitivity, specificity, PLR, and PPV were 90.90%, 73%, 3.36, and 50%, respectively. Altered microvascular pattern was identified as a risk factor for high-risk GC development in GIM (p < 0.001; odds ratio [OR] = 4.696; 95% CI 2.792–7.896). The modified EGGIM model achieved an AUC of 0.921 (95% CI 0.873–0.968) for identifying OLGIM III-IV; at the cutoff value ≥ 2.5, the sensitivity, specificity, PLR, and PPV were 97%, 66.70%, 2.91, and 46.4%, respectively. After incorporating MV, the AUC of the EGGIM score increased from 0.885 to 0.921, suggesting improved diagnostic performance.Conclusions Microvascular pattern serves as a significant independent predictor for OLGIM III-IV. The modified EGGIM demonstrated good diagnostic performance for OLGIM III-IV, suggesting its potential as a non-invasive endoscopic tool for assessing the risk stratification of GC development.

Source: Annals of Medicine

DOI: 10.1080/07853890.2026.2668887