S3195 Standardizing the Approach to Gastric Intestinal Metaplasia: A Quality Improvement Initiative in Sampling, Reporting, and Surveillance

Introduction: Gastric intestinal metaplasia (GIM) is a premalignant condition that requires standardized biopsy and reporting per American College of Gastroenterology guidelines. However, adherence to protocols like the Sydney protocol and comprehensive documentation of histopathologic findings remains inconsistent. This quality improvement study evaluates real-world GIM practices at a tertiary center to identify gaps in sampling, reporting, and surveillance. Methods: We conducted a retrospective review of adults who underwent esophagogastroduodenoscopy (EGD) for various indications with incidental diagnosis of GIM on histopathology from May 2020 to November 2024. Patients with prior gastric cancer or gastric surgery were excluded. Data collected included demographics, risk factors, index EGD indication, and whether follow-up gastric mapping was performed. For those with repeat EGD, we examined biopsy techniques, including site, number, and adherence to the Sydney protocol with site-specific specimen separation, pathology reporting (subtype, extent, H. pylori, atrophic gastritis), and surveillance. Results: Of 100 charts reviewed, 78 met inclusion criteria. Mean age was 61 years; 63% were women. H. pylori history was noted in 26% and 4% had a first-degree relative with gastric cancer. Common EGD indications included gastroesophageal reflux disease, dyspepsia, and iron deficiency anemia. Repeat mapping was performed in 99% of cases. Biopsy sampling varied with only 48% cases following Sydney protocol including ≥2 biopsies from antrum, ≥2 biopsies from the corpus, ≥1 biopsy from the incisura. In 94% of cases, each biopsy specimen was placed in an individual container regardless of site, while the rest grouped specimens by anatomic site. Persistent GIM was found in 63%, of which 50% was focal, 25% extensive, and 25% unspecified. Subtyping showed 76% complete intestinal metaplasia, 6% incomplete, 11% mixed, and 8% unspecified. Surveillance plans were documented in only 43% of cases. Conclusion: Our study shows that while most patients underwent repeat mapping, biopsy techniques and histopathology reporting were suboptimal, and over half lacked a documented surveillance plan. These gaps highlight the need for standardized sampling and pathology frameworks to improve guideline adherence and risk stratification. We plan to conduct educational workshops for endoscopists and pathologists, protocolize biopsy sampling, create pathology reporting templates, and adopt risk-based surveillance guidelines. Post-intervention data analysis will be conducted to assess the effectiveness of these measures.