Clinical Epidemiology and Outcomes of Patients with Gastric Intestinal Metaplasia in the Los Angeles County Hospital System

Abstract

AbstractBackground:Gastric intestinal metaplasia (GIM) is a precursor to gastric adenocarcinoma (GAC). In the United States (US), there is no consensus on the utility of surveillance for GIM, and minority populations most affected by this cancer are understudied. Our aims were to define clinical and endoscopic features, surveillance practices, and outcomes in patients with GIM in a multicenter safety-net system.Methods:We identified patients with biopsy-proven GIM between 2016-2020 at the three medical centers comprising Los Angeles County Department of Health Services (LADHS). Demographics,endoscopic, and histologic findings on esophagoduodenoscopy (EGD) first showing GIM, recommended interval for repeat (surveillance) EGD,and findings at repeat EGD were abstracted. Descriptive statistics were performed to characterize our cohort. T-tests and chi-squared (c2) tests were used to compare patients with and without multifocal GIM.Results:There were 342 patients with newly-diagnosed biopsy-proven GIM. Hispanic patients comprised 71.8% followed by Asians (12.4%). One-third of patients had a history ofH. pylori. For most patients (59%), repeat EGD was not recommended. If recommended, 2-3 years was the most common interval. Over a median time to repeat EGD of 13 months and cumulative follow-up of 119 patient-years, 29.5% of patients underwent repeat EGD, of which 14% of patients had multifocal GIM not previously detected. There was no progression to dysplasia or GAC.Conclusion:In a predominantly minority population with biopsy-proven GIM, there appears to be relatively slow progression of disease. Based on our findings, GIM surveillance EGD can likely be deferred at least 1-2 years.