Optimizing endoscopic detection of precancerous gastric conditions: Single-center prospective study

Chronic atrophic gastritis is an asymptomatic precancerous condition that can progress to extensive atrophy and/or intestinal metaplasia (IM), referred to as advanced stage of atrophic gastritis (ASAG). ASAG is a common condition with a variable prevalence worldwide reaching 45%. Narrow-band imaging (NBI) already has an established role in improving endoscopic detection of atrophy and IM. Considering the heterogeneous hospital population, this study aimed to assess the ASAG detection rate with NBI-guided biopsies compared with conventional Sydney protocol, in a European cosmopolitan city hospital.

This was a prospective, single-center, bi-phasic study conducted between October 2023 and March 2024, comparing ASAG detection rates using conventional Sydney protocol with optional NBI use, defined as phase 1, versus systematic NBI-guided biopsies in phase 2.

Of 495 eligible patients, 435 with similar demographics were included in both phases (87.8%). ASAG was detected in three patients using conventional Sydney protocol (1.43%) compared with eight patients (3.56%) using systematic NBI-guided biopsies ( P = 0.269). Furthermore, systematic NBI-guided biopsies were associated with increased detection rates for atrophy and IM ( P = 0.223 and P = 0.502, respectively). Suspicion-free NBI use correlated with increased likelihood of ASAG detection (odds ratio 16.99, 95% confidence interval 2.30-213.73). Age ≥ 50 years was a significant risk factor associated with ASAG.

Despite the diverse hospital population, ASAG prevalence remained low. A numerical increase in ASAG detection rate was observed with systematic NBI use compared with optional NBI use. Overall, systematic NBI-guided biopsies appear to be associated with increased rates of detection of ASAG, atrophy, and IM.