The Predictive Value of the EGGIM Score for Extensive and Incomplete Gastric Intestinal Metaplasia: Implications for Biopsy Reduction in Endoscopic Practice.

[BACKGROUND] Gastric intestinal metaplasia (IM) is a precancerous lesion, with high-risk IM (i.e., extensive or incomplete types) posing the most significant risk for gastric cancer. The endoscopic grading of gastric intestinal metaplasia (EGGIM) was developed to predict the presence of IM; however, validation studies in Asian populations are limited. This study aimed to evaluate the performance of the EGGIM in predicting IM and high-risk IM among Vietnamese patients with upper gastrointestinal symptoms.

[METHODS] In this cross-sectional study, patients underwent upper gastrointestinal endoscopy with IM assessment using the EGGIM score. All patients received systematic biopsies for histopathological evaluation. IM was classified as extensive if it was present in both the antrum and corpus. The IM subtype was determined using Alcian Blue and periodic acid-Schiff (PAS) staining. The predictive performance of the EGGIM for IM and high-risk IM was evaluated using the area under the receiver operating characteristic curve (AUC).

[RESULTS] A total of 295 patients were included, with a median age of 51 years and a male-to-female ratio of 1:2. The prevalence of IM was 37.3%, with 18.0% having high-risk IM (10.5% extensive and 13.9% incomplete). The EGGIM score demonstrated good predictive accuracy for IM (AUC = 0.87, 95% CI: 0.82-0.92, cutoff ≥ 1) and for high-risk IM (AUC = 0.92, 95% CI: 0.87-0.97, cutoff ≥ 5).

[CONCLUSION] The EGGIM score accurately predicts both IM and high-risk IM. It may serve as a practical, noninvasive tool to guide biopsy decisions and identify patients at elevated risk of gastric cancer.