Association of endoscopic biopsy sampling methods with detection of precursor lesions of gastric cancer

Abstract

The yield of various endoscopic biopsy sampling methods for detection of precursor lesions of non-cardia gastric cancer in a real-world setting remains unclear. Our objective was to evaluate the association of endoscopic biopsy sampling methods with detection of gastric intestinal metaplasia (GIM) and dysplasia (GD). We conducted a case-control study of adult patients who underwent esophagogastroduodenoscopy (EGD) with biopsy between 2010-2021 in a racially/ethnically diverse United States healthcare system. Cases were patients with histopathologic findings of GIM and/or GD. Controls were matched 1:1 by age, procedure date, and medical center. We compared the detection of GIM/GD using four different biopsy sampling methods: unspecified, specified stomach location, two-plus-two, and Sydney protocol. Additionally, we assessed trends in use of sampling methods (Cochrane-Armitage) and identified patient/endoscopist factors associated with their use (logistic regression). We identified a total of 20,938 GIM and 455 GD matched pairs. A greater proportion of GIM-cases were detected using two-plus-two (31.3%vs25.3%, p<0.0001) and Sydney (9.1%vs1.0%, p<0.0001) compared to controls. Similarly, a greater proportion of GD-cases were detected using Sydney (15.6%vs0.4%, p<0.0001). We observed an increasing trend in the use of the Sydney protocol during the study period (3.8% to 16.1% in cases, p<0.0001; 1% to 1.1% in controls, p=0.005). Male and Asian-American patients were more likely to undergo two-plus-two or Sydney, while female and Hispanic endoscopists were more likely to perform sampling using these protocols. The application of the Sydney protocol is associated with an increased detection of precursor lesions of gastric cancer in routine clinical practice.