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Gastric intestinal metaplasia: when to treat? How to treat?

Thaer Abdelfattah1,2, Omer Shahab1,2, Tilak U Shah1,2

  • 1Division of Gastroenterology and Hepatology, Virginia Commonwealth University.

Current Opinion in Gastroenterology
|August 25, 2021
PubMed
Abstract

Insights

Gastric intestinal metaplasia (GIM) surveillance is not universal but recommended for high-risk patients. Endoscopic resection is effective for GIM with visible dysplasia or early gastric cancer (GAC).

Area of Science:

  • Gastroenterology
  • Oncology
  • Endoscopy

Background:

  • Gastric intestinal metaplasia (GIM) is a precursor to gastric adenocarcinoma (GAC).
  • Current surveillance and treatment strategies for GIM are debated due to variable progression rates.
  • Identifying patients who benefit from interventions remains a clinical challenge.

Purpose of the Study:

  • To review current GIM surveillance guidelines.
  • To identify GIM patients who may benefit from treatment.
  • To summarize recent literature on GIM therapeutic interventions.

Main Methods:

  • Review of published guidelines from major gastroenterology societies.
  • Analysis of randomized trials and pivotal literature on GIM therapy.
  • Evaluation of endoscopic surveillance, H. pylori eradication, and endoscopic resection/ablation.

Main Results:

  • Universal GIM surveillance is not recommended, but suggested for patients with risk factors for GAC.
  • Helicobacter pylori eradication reduces the risk of dysplasia and GAC.
  • Endoscopic resection is beneficial for GIM with visible dysplasia and early GAC.
  • Endoscopic ablation shows promise for extensive or invisible dysplasia.

Conclusions:

  • Endoscopic resection is indicated for persistent visible dysplasia or early GAC after H. pylori eradication.
  • Further prospective studies are required to evaluate endoscopic ablation efficacy in GIM.

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