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

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: < 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.