Isajevs Sergejs, Liepniece-Karele Inta, Janciauskas Dainius, Moisejevs Georgijs, Funka Konrads, Kikuste Ilze, Vanags Aigars, Tolmanis Ivars, Leja Marcis
aFaculty of Medicine, University of Latvia bRiga East University Hospital cDigestive Diseases Centre GASTRO dAcademic Histology Laboratory, Riga, Latvia eFaculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Eur J Gastroenterol Hepatol. 2014 May;26(5):510-3. doi: 10.1097/MEG.0000000000000082.
It is important to stratify patients according to the magnitude of risk for gastric cancer development; the OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link on Gastric Intestinal Metaplasia) staging systems of lesions in the stomach mucosa have been proposed for this purpose. There are some discrepancies in the current guidelines regarding the value of incisura angularis biopsies. The aim of our study was to assess the value of incisura angularis biopsy in staging gastritis according to the OLGA and OLGIM systems by examining the atrophic, metaplastic and inflammatory changes in the antrum, incisura angularis and corpus.
We enrolled 835 patients undergoing upper endoscopy. Three expert gastrointestinal pathologists graded biopsy specimens according to the Sydney classification and the stage of gastritis was assessed by the OLGA and OLGIM systems.
The results demonstrated that severe atrophic, metaplastic and chronic inflammatory changes were more frequently observed in the incisura angularis mucosa than in the antrum or corpus mucosae (P<0.05). There was a general downgrading of stage by 18.0% for OLGA and by 4.0% for OLGIM when the incisura angularis was excluded from the staging. Furthermore, there was a 30-35% downgrading for high-risk OLGA/OLGIM stages.
The incisura angularis undergoes more severe atrophic, metaplastic and chronic inflammatory changes than the antrum and corpus. Incisura angularis biopsies should be routinely included in the biopsy sampling protocol.
根据胃癌发生风险程度对患者进行分层很重要；为此已提出胃黏膜病变的OLGA（胃炎评估手术关联）和OLGIM（胃小肠化生手术关联）分期系统。目前关于角切迹活检价值的指南存在一些差异。我们研究的目的是通过检查胃窦、角切迹和胃体的萎缩、化生及炎症变化，评估角切迹活检在根据OLGA和OLGIM系统对胃炎进行分期中的价值。
我们纳入了835例行上消化道内镜检查的患者。三位专业胃肠病理学家根据悉尼分类法对活检标本进行分级，并通过OLGA和OLGIM系统评估胃炎分期。
结果表明，角切迹黏膜中重度萎缩、化生及慢性炎症变化比胃窦或胃体黏膜更常见（P<0.05）。当分期中排除角切迹时，OLGA分期总体下调18.0%，OLGIM分期下调4.0%。此外，高危OLGA/OLGIM分期下调30 - 35%。
角切迹比胃窦和胃体发生更严重的萎缩、化生及慢性炎症变化。角切迹活检应常规纳入活检采样方案。
