Sa1135 Self-Expandable Metal Stents or Surgery in Colonic Obstruction: Which is Better?

Abstract

Introduction: Endoscopic findings such as erythema are frequently labelled as gastritis. Some previous studies have shown reasonable concordance between endoscopy and histology findings while others demonstrate a very poor correlation. Aims: To study the positive and negative predictive values of endoscopic diagnosis of antral gastritis and gastropathy. Method: 400 consecutive patients who underwent an OGD and had at least two antral biopsies were included in the study retrospectively. The endoscopic results were then compared to the histology reports for concordance. Only endoscopic reports of antral gastritis according to the criteria described by the Sydney classification were considered ‘positive for antral gastritis'. Histologically, those reported as acute or chronic inflammation, Helicobacter-associated gastritis, chemical or reactive gastritis, hypertrophic gastropathy, eosinophilic gastritis, lymphocytic gastritis, collagenous gastritis and granulomatous gastritis were regarded as being ‘positive for antral gastritis'. Results: In total, there were 182 male patients and 218 female patients. The median age was 50.5 ± 17.2 years (range 15 to 91). The endoscopic appearance of the antrum was positive for gastritis in 51.0% (204/400) of patients and was negative in 49.0% (196/400) of patients. The percentages of patients with presence of inflammation on histology were similar in those with or without endoscopic gastritis (65.7% vs 60.7%, p=0.303). Of the 17.3% (69/400) patients who were eventually diagnosed and treated for Helicobacter-associated gastritis on biopsy, 55.1% (38/400) had endoscopic evidence of gastritis and 44.9% (31/400) of patients did not, p=0.267. The positive and negative predictive values of endoscopy in predicting histological antral gastritis were 39.3% and 65.7% respectively. Conclusion: The predictive values of the endoscopic appearance in the diagnosis of antral gastritis is extremely poor. An endoscopically non-inflamed antrum is as likely as an inflamed antrum to harbour significant pathology such as Helicobacter pylori. Hence, it is essential to obtain antral biopsies in all patients.