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    Follow-up for patients with intestinal metaplasia restricted to the antrum
    (GALENOS YAYINCILIK, 2020) Koç, Deniz Öğütmen; Hülagü, Sadettin; Gürbüz, Yeşim Saliha; Çelebi, Altay; Duman, Ali Erkan; Kazaz, Tanyeli Güneyligil
    Objective: Guidelines recommend endoscopic surveillance for patients with extensive atrophy/intestinal metaplasia (IM), but follow-up is not recommended for patients with atrophy/IM restricted to the antrum. We evaluated the risk of neoplastic lesions in patients with antrum-restricted IM to determine whether surveillance endoscopy is necessary. Methods: Overall, 117 patients with antrum-restricted IM diagnosed within the past 10 years underwent surveillance endoscopy. The gastric biopsy specimens were evaluated for atrophy, IM, and dysplasia. Results: We enrolled 117 patients. Surveillance endoscopy was performed at a median (interquartile range) of 7.2 years (5.9-8.7 years) after the initial diagnosis of IM. On surveillance endoscopy, 27.4% of patients exhibited progression in their IM grade, whereas 25.6% had atrophy progression, and 33.3% had dysplasia progression. High-grade dysplasia and gastric cancer (GC) were detected in four and two patients, respectively. The annual incidence of GC in patients with antrum-restricted IM was 0.17%. IM grade and type regressed in 29.9% and 38.5% of patients, respectively. Most patients with progressive IM grade, IM type, and dysplasia on surveillance endoscopy had Operative Link on Gastritis Assessment (OLGA) stage 3-4 (p=0.0001, p=0.008, and p=0.0001, respectively), and most patients with progressive atrophy and dysplasia had Operative Link on Gastric IM (OLGIM) stage 3-4 (both p=0.001). Conclusion: Patients with IM restricted to the antrum are at risk for neoplastic lesions and require endoscopic surveillance, contrary to existing recommendations. Premalignant lesions can exhibit both progression and regression. Therefore, a patient-specific surveillance program based on OLGA and OLGIM might be appropriate.