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Vol. 47. Issue 8.
Pages 793-803 (October 2024)
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Vol. 47. Issue 8.
Pages 793-803 (October 2024)
Original article
Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study
La implementación del protocolo de biopsia del sistema de Sydney actualizado mejora el rendimiento diagnóstico de las condiciones preneoplásicas gástricas: resultados de un estudio en el mundo real
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Gonzalo Latorrea,1, José Ignacio Vargasa,1, Shailja C. Shahb,c, Danisa Ivanovic-Zuvicd, Pablo Achurrae, Martín Fritzschef, Jai-Sen Leungf, Bernardita Ramosf, Elisa Jensenf, Javier Uribea, Isabella Monterof, Vicente Gandaraf, Camila Roblesf, Miguel Bustamantef, Felipe Silvaf, Eitan Dukesf, Oscar Corsia, Francisca Martínezf, Victoria Binderf, Roberto Candiaa..., Robinson Gonzáleza, Alberto Espinoa, Carlos Agüeroa, Allan Sharpe, Javiera Torresg, Juan Carlos Roag,h, Margarita Pizarroa, Alejandro H. Corvalani,j, Charles S. Rabkink, M. Constanza Camargok, Arnoldo Riquelmea,h,
Corresponding author
a.riquelme.perez@gmail.com

Corresponding author.
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a Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
b Gastroenterology Section, Veterans Affairs, San Diego Healthcare System, San Diego, CA, USA
c Division of Gastroenterology, University of California, San Diego, San Diego, CA, USA
d Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
e Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
f School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
g Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
h Center for Cancer Prevention and Control, CECAN, Chile
i Department of Hematology and Oncology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
j Advanced Center for Chronic Diseases (ACCDIS), Santiago, Chile
k Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Tables (3)
Table 1. Endoscopist characteristics stratified by updated Sydney system biopsy protocol regular vs. infrequent use.
Table 2. Patient characteristics by endoscopy group.
Table 3. Chronic atrophic gastritis with or without gastric intestinal metaplasia according to anatomical location and its association to endoscopist group.
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Additional material (1)
Abstract
Background

The updated Sydney system biopsy protocol (USSBP) standardizes the sampling of gastric biopsies for the detection of preneoplastic conditions (e.g., gastric intestinal metaplasia [GIM]), but the real-world diagnostic yield is not well-described.

Aim

To determine whether regular application of USSBP is associated with higher detection of chronic atrophic gastritis (CAG), GIM and autoimmune gastritis (AIG).

Methods

We performed a real-world retrospective study at an academic urban tertiary hospital in Chile. We manually reviewed medical records from consecutive patients undergoing esophagogastroduodenoscopy (EGD) from January to December 2017. Seven endoscopists who performed EGDs were categorized into two groups (USSBP ‘regular’ and USSBP ‘infrequent’) based on USSBP adherence, using minimum 20% adherence as the prespecified threshold. Multivariable logistic regression models were used to estimate the odds ratios (aOR) and 95% confidence intervals (CI) for the association between endoscopist groups and the likelihood of diagnosing CAG, GIM or AIG.

Results

1206 patients were included in the study (mean age: 58.5; 65.3% female). The USSBP regular group demonstrated a higher likelihood of detecting CAG (20% vs. 5.3%; aOR 4.03, 95%CI: 2.69–6.03), GIM (12.2% vs. 3.4%; aOR 3.91, 95%CI: 2.39–6.42) and AIG (2.9% vs. 0.8%; aOR 6.52, 95%CI: 1.87–22.74) compared to infrequent group. Detection of advanced-stage CAG (Operative Link for Gastritis Assessment stage III/IV) was significantly higher in the USSBP regular vs. infrequent group (aOR 5.84, 95%CI: 2.23–15.31).

Conclusions

Routine adherence to USSBP increases the detection rates of preneoplastic conditions, including CAG, GIM and AIG. Standardized implementation of USSBP should be considered in high gastric cancer risk populations.

Keywords:
Helicobacter pylori
Gastric cancer
Endoscopy
Gastritis
Resumen
Introducción

El protocolo de biopsia del sistema de Sydney actualizado (Updated Sydney System biopsy protocol [USSBP]) estandariza la toma de muestras de biopsias gástricas para la detección de condiciones preneoplásicas (p. ej., la metaplasia intestinal gástrica (MIG)), pero el rendimiento diagnóstico en el mundo real no está bien descrito.

Objetivo

Determinar si la aplicación regular del USSBP se asocia con una mayor detección de gastritis crónica atrófica (GCA), MIG y gastritis autoinmune (GAI).

Métodos

Estudio retrospectivo del mundo real en un hospital terciario urbano académico en Chile. Revisamos manualmente los registros médicos de pacientes consecutivos sometidos a una endoscopía digestiva alta (EDA) desde enero hasta diciembre de 2017. Siete endoscopistas que realizaron EDA fueron categorizados en 2 grupos (USSBP «regular» y USSBP «infrecuente») según su adhesión al USSBP, utilizando un umbral predefinido de adhesión>20%. Se utilizaron modelos de regresión logística multivariable expresadas en odds ratio (OR) e intervalos de confianza del 95% (IC 95%) para la asociación entre los grupos de endoscopistas y la probabilidad de diagnosticar GCA, MIG o GAI.

Resultados

Se incluyeron 1.206 pacientes en el estudio (edad promedio: 58,5 años; 65,3% mujeres). El grupo USSBP «regular» demostró una mayor probabilidad de detectar GCA (20 vs. 5,3%; OR: 4,03; IC 95%: 2,69-6,03), MIG (12,2 vs. 3,4%; OR: 3,91; IC 95%: 2,39-6,42) y GAI (2,9 vs. 0,8%; OR: 6,52; IC 95%: 1,87-22,74) en comparación con el grupo USSBP «infrecuente». La detección de GCA en etapa avanzada (etapa III/IV de Operative Link for Gastritis Assessment [OLGA]) fue significativamente mayor en el grupo USSBP «regular» vs. USSBP «infrecuente» (OR: 5,84; IC 95%: 2,23-15,31).

Conclusiones

La adherencia rutinaria al USSBP aumenta las tasas de detección de condiciones preneoplásicas, incluyendo GCA, MIG y GAI. La implementación estandarizada del USSBP debería considerarse en poblaciones con alto riesgo de cáncer gástrico.

Palabras clave:
Helicobacter pylori
Cáncer gástrico
Endoscopía
Gastritis

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