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. 2024 Oct;47(8):793-803.
doi: 10.1016/j.gastrohep.2023.08.005. Epub 2023 Aug 19.

Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study

[Article in English, Spanish]
Gonzalo Latorre  1 , José Ignacio Vargas  1 , Shailja C Shah  2 , Danisa Ivanovic-Zuvic  3 , Pablo Achurra  4 , Martín Fritzsche  5 , Jai-Sen Leung  5 , Bernardita Ramos  5 , Elisa Jensen  5 , Javier Uribe  1 , Isabella Montero  5 , Vicente Gandara  5 , Camila Robles  5 , Miguel Bustamante  5 , Felipe Silva  5 , Eitan Dukes  5 , Oscar Corsi  1 , Francisca Martínez  5 , Victoria Binder  5 , Roberto Candia  1 , Robinson González  1 , Alberto Espino  1 , Carlos Agüero  1 , Allan Sharp  4 , Javiera Torres  6 , Juan Carlos Roa  7 , Margarita Pizarro  1 , Alejandro H Corvalan  8 , Charles S Rabkin  9 , M Constanza Camargo  9 , Arnoldo Riquelme  10
Affiliations

Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study

[Article in English, Spanish]
Gonzalo Latorre et al. Gastroenterol Hepatol. 2024 Oct.

Abstract
in English, Spanish

Background: The updated Sydney system biopsy protocol (USSBP) standardizes the sampling of gastric biopsies for the detection of preneoplastic conditions (e.g., gastric intestinal metaplasia [GIM]), but the real-world diagnostic yield is not well-described.

Aim: To determine whether regular application of USSBP is associated with higher detection of chronic atrophic gastritis (CAG), GIM and autoimmune gastritis (AIG).

Methods: We performed a real-world retrospective study at an academic urban tertiary hospital in Chile. We manually reviewed medical records from consecutive patients undergoing esophagogastroduodenoscopy (EGD) from January to December 2017. Seven endoscopists who performed EGDs were categorized into two groups (USSBP 'regular' and USSBP 'infrequent') based on USSBP adherence, using minimum 20% adherence as the prespecified threshold. Multivariable logistic regression models were used to estimate the odds ratios (aOR) and 95% confidence intervals (CI) for the association between endoscopist groups and the likelihood of diagnosing CAG, GIM or AIG.

Results: 1206 patients were included in the study (mean age: 58.5; 65.3% female). The USSBP regular group demonstrated a higher likelihood of detecting CAG (20% vs. 5.3%; aOR 4.03, 95%CI: 2.69-6.03), GIM (12.2% vs. 3.4%; aOR 3.91, 95%CI: 2.39-6.42) and AIG (2.9% vs. 0.8%; aOR 6.52, 95%CI: 1.87-22.74) compared to infrequent group. Detection of advanced-stage CAG (Operative Link for Gastritis Assessment stage III/IV) was significantly higher in the USSBP regular vs. infrequent group (aOR 5.84, 95%CI: 2.23-15.31).

Conclusions: Routine adherence to USSBP increases the detection rates of preneoplastic conditions, including CAG, GIM and AIG. Standardized implementation of USSBP should be considered in high gastric cancer risk populations.

Introducción:: El protocolo de biopsia del sistema de Sydney actualizado (Updated Sydney System biopsy protocol: USSBP) estandariza la toma de muestras de biopsias gástricas para la detección de condiciones preneoplásicas (ej. metaplasia intestinal gástrica: MIG), pero el rendimiento diagnóstico en el mundo real no está bien descrito.

Objetivo:: Determinar si la aplicación regular del USSBP se asocia con una mayor detección de gastritis crónica atrófica (GCA), MIG y gastritis autoinmune (GAI).

Métodos:: Estudio retrospectivo del mundo real en un hospital terciario urbano académico en Chile. Revisamos manualmente los registros médicos de pacientes consecutivos sometidos a una endoscopía digestiva alta (EDA) desde enero hasta diciembre de 2017. Siete endoscopistas que realizaron EDAs fueron categorizados en dos grupos (USSBP 'regular' y USSBP 'infrecuente') según su adhesión al USSBP, utilizando un umbral predefinido de adhesión >20%. Se utilizaron modelos de regresión logística multivariable expresadas en Odds Ratio (OR) e intervalos de confianza del 95% (IC) para la asociación entre los grupos de endoscopistas y la probabilidad de diagnosticar GCA, MIG o GAI.

Resultados:: Se incluyeron 1.206 pacientes en el estudio (edad promedio: 58,5 años; 65,3% mujeres). El grupo USSBP 'regular' demostró una mayor probabilidad de detectar GCA (20% vs. 5,3%; OR 4,03, IC95%:2,69-6,03), MIG (12,2% vs. 3,4%; OR 3,91, IC95%:2,39-6,42) y GAI (2,9% vs. 0,8%; OR 6,52, IC95%:1,87-22,74) en comparación con el grupo 'infrecuente'. La detección de GCA en etapa avanzada (etapa III/IV de Operative Link for Gastritis Assessment: OLGA) fue significativamente mayor en el grupo USSBP 'regular' vs. USSBP 'infrecuente' (OR 5,84, IC95%:2,23-15,31).

Conclusiones:: La adherencia rutinaria al USSBP aumenta las tasas de detección de condiciones preneoplásicas, incluyendo GCA, MIG y GAI. La implementación estandarizada del USSBP debería considerarse en poblaciones con alto riesgo de cáncer gástrico.

Keywords: Cáncer gástrico; Endoscopy; Endoscopía; Gastric cancer; Gastritis; Helicobacter pylori.

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Conflict of interest statement

Potential competing interests: The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Gastric biopsies sample collection sites according to Updated Sydney System biopsy protocol, cassette used for biopsies storage and disposition in plate for microscopy.
Figure 2.
Figure 2.
Differences in frequency of detection of chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) in Updated Sydney system biopsy protocol (USSBP) regular group compared to infrequent group. Panel A shows differences in frequency of overall CAG and GIM. Panel B shows differences in frequency by OLGA stages.
Figure 3.
Figure 3.
Correlation between histologically diagnosis of chronic atrophic gastritis (Panel A) and gastric intestinal metaplasia (Panel B) according to frequency of application of mapping gastric biopsies following Updated Sydney system biopsy protocol (USSBP), out of the esophagogastroduodenoscopy performed by each endoscopist. The blue dotted line indicates the 20% cut-off point set to define the adhesion to USSBP.
Figure 4.
Figure 4.
Logistic regression of variables associated to the implementation of USSBP. CI: Confidence interval; CAG: Chronic atrophic gastritis; EGD: Esophagogastroduodenoscopy; GC: Gastric cancer; GIM: Gastric intestinal metaplasia.
See this image and copyright information in PMC

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