Abstract

Introduction: Gastric cancer (GC) is the leading cause of cancer mortality in Chile. The development of gastric adenocarcinoma its preceded by a histopathologic cascade composed of gastric atrophy, intestinal metaplasia and gastric dysplasia. Sydney protocol has been proposed as the standard method for diagnosing these conditions. The aim of this research study was to establish whether Sydney protocol increase the detection of premalignant gastric lesions, as gastric atrophy and intestinal metaplasia, compared to nonprotocolized endoscopies/biopsies. Methods: Upper gastroduodenal endoscopies (GDE) from Hospital Clínico Universidad Católica de Chile between April-May 2015 and April-May 2016 was analyzed. Patients with histological study with 18 years-old or older were included. Patients with history of GC or malignant lesions at GDE where excluded. Detection of gastric atrophy, intestinal metaplasia and suggestive findings of autoimmune gastritis where compared between Sydney protocol and non-protocolized endoscopies/biopsies. Results: One hundred twenty-six GDE with Sydney protocol and 146 non-protocolized GDE where included. The mean age at Sydney group was 56 years-old, compared with 61 years-old (p = 0.03), 63.7% of patients were men with no differences between both groups (p = 0.45). No differences on GDE findings were observed between both groups. Helicobacter pylori infection was observed with Giemsa staining in 49.2% patients with Sydney protocol and 20.5% of non-protocolized study (p < 0.001). Gastric atrophy was observed in 51.6% of patients with Sydney protocol, compared to 19.9% on non-protocolized study (p < 0.001). Also, more intense gastric atrophy was observed on Sydney protocol group compared with non-protocolized study, 12.1% compared with 4.1% respectively (p = 0.015). Gastric intestinal metaplasia was similar in both groups (30.6% vs 24%; p = 0.219). More suggestive findings of autoimmune gastritis were observed in Sydney protocol group (3.2% vs 0%; p = 0.029). Conclusion: Sydney protocol increases the detection of Helicobacter pylori infection, gastric atrophy, intense gastric atrophy and autoimmune gastritis compared to non-protocolized study. However, no differences were observed in the detection of gastric intestinal metaplasia. Based on these findings, Sydney protocol should be considered as a potential strategy to increase the detection of premalignant gastric lesions for the prevention of GC in countries with high prevalence of this disease.