OLGA and OLGIM Stages for Predicting Metachronous Gastric Neoplasm After Endoscopic Submucosal Dissection in Patients...

The operative link on gastritis assessment (OLGA) and operative link on gastritis assessment based on intestinal metaplasia (OLGIM) are established tools for stratifying the risk of gastric neoplasm development. This study evaluated whether OLGA and OLGIM staging can predict metachronous gastric neoplasms (adenoma or cancer) after endoscopic submucosal dissection (ESD) in patients with early gastric cancer (EGC) without current Helicobacter pylori infection.

This retrospective cohort study enrolled 494 patients with EGC without current H. pylori infection who underwent ESD between 2004 and 2015. The primary endpoint was the incidence of metachronous gastric neoplasms. High risk was defined as OLGA or OLGIM stage III-IV.

Of the included patients, 55.4% (250/451) and 55.9% (276/494) were classified as high risk according to OLGA and OLGIM staging, respectively. During a median follow-up of 6.8 years, the incidence of metachronous gastric neoplasm was 26.6 cases per 1,000 person-years. According to OLGA staging, the high-risk group had a significantly higher incidence of metachronous neoplasms than the low-risk group (33.3 vs. 17.8 cases per 1,000 person-years, log-rank test P=0.012). Similarly, according to OLGIM staging, the high-risk group demonstrated a significantly higher incidence than the low-risk group (35.2 vs. 16.6 cases per 1,000 person-years, P=0.002).

In patients with EGC without current H. pylori infection, OLGA and OLGIM staging are useful for assessing the risk of metachronous gastric. The current 5-year endoscopic surveillance interval after ESD may be further optimized according to patient risk stratified by OLGA or OLGIM stages.