Endoscopic grading of gastric atrophy on risk assessment of gastric neoplasia: A systematic review and meta‐analysis

BACKGROUND AND AIM Endoscopic examination of gastric atrophy has been developed to determine the extent of atrophy by identifying the atrophic border of gastric mucosa, but its value in predicting the risk of developing gastric neoplasms is not quantified. Thus, this systematic review and meta-analysis aim to assess the incidence risk of gastric neoplasms on the basis of endoscopic grading of gastric atrophy. METHODS Two authors independently searched the electronic databases (PubMed, Embase, and the Cochrane Library) through 31 December 2019, without language restriction. The effect size on study outcomes is calculated using random-effect model and presented as risk ratio (RR) with 95% confidence interval (CI). Heterogeneity, publication bias and quality of included studies were also assessed. RESULTS 14 retrospective studies are identified to perform systematic review and meta-analysis, 11 were cohort study and 3 were cross-sectional research. The pooled RR for developing gastric neoplasms is 3.89 (95%CI 2.92-5.17) among general patients with severe endoscopic atrophy. For patients underwent endoscopic resection for early gastric neoplasms, nearly two times increased risk of synchronous or metachronous neoplasms is pooled (RR=1.96, 95%CI 1.39-2.75). In terms of the type of endoscopic atrophy, patients with open-type endoscopic atrophy have a higher risk of gastric cancer development (RR=7.27; 95%CI 1.64-32.33) than close-type. CONCLUSIONS Grading endoscopic atrophy according to the Kimura-Takemoto classification can assess the risk of gastric neoplasia development. Patients with severe or open-type endoscopic gastric atrophy at baseline should undergo rigorous surveillance to early detect premalignant lesions and cancer.