Table 1.
MAPS II and AGA recommendations for endoscopic surveillance of histologically diagnosed gastric atrophy
| Condition | OLGA | OLGIM | Follow-up interval in years | ||
|---|---|---|---|---|---|
| MAPS II | AGA1 | ||||
| Atrophy without intestinal metaplasia (includes pseudopyloric metaplasia) | |||||
| Antrum/incisura only | Mild/moderate* | I/II | 0 | No F-U | NA |
| Severe | III | 0 | 3 | NA | |
| Corpus only | Mild/moderate | I/II | 0 | No F-U | NA |
| Severe | II | 0 | No F-U | NA | |
| Both | Mild | I | 0 | No F-U | NA |
| Moderate | III | 0 | 3 | NA | |
| Severe | IV | 0 | 3 | NA | |
| Other combinations | II-IV | 0 | No F-U versus 32 | NA | |
| IM | |||||
| Antrum/incisura only | Mild/moderate | I-IV | I | No F-U versus 32 | No F-U |
| Severe | III-IV | III | 3 | No F-U | |
| Complete type** | No F-U | No F-U | |||
| Incomplete/mixed type | 3 | 3–5 | |||
| Corpus only | Mild/moderate | I-IV | I/II | No F-U versus 32 | No F-U |
| Severe | II-IV | II | No F-U versus 32 | No F-U | |
| Complete type** | No F-U | No F-U | |||
| Incomplete/mixed type | 3 | 3–5 | |||
| Both | Mild/moderate/severe | I-IV | I-IV | 3 | 3–5 |
| Complete | 3 | 3–5 | |||
| Incomplete/mixed type | 3 | 3–5 | |||
| IM + family history of GC*** | 33 | 3–5 | |||
| IM + persistent H. pylori infection | 34 | NA | |||
| Autoimmune gastritis | 3–5 | NA | |||
F-U follow-up, IM intestinal metaplasia, NA non-applicable/not considered in the guidelines, OLGA operative link on gastritis assessment, OLGIM operative link on intestinal metaplasia assessment
Mild, moderate, or severe denote histological extension of atrophy (by OLGA and OLGIM systems). It is calculated separately in antrum/incisura (average of 3 biopsies) and corpus (average of 2 biopsies)
Follow-up for patients with complete-type IM in only one anatomical location should be based on IM extension and other risk factors
These recommendations do not apply to hereditary/familial diffuse GC
Using shared decision making, patients with IM and concerns about completeness of baseline endoscopy, extensive, or incomplete-type IM, and/or who are specifically at overall increased risk for GC (racial/ethnic minorities, immigrants from high GC risk regions, or family history of GC) may elect for repeat endoscopy within 1 year for risk stratification
Follow-up recommended if OLGA stage is III or IV
Individuals with advanced stages of gastric atrophy (not only IM) and family history of GC may benefit from follow-up every 1–2 years
In individuals with extensive IM, the follow-up interval may be 1–2 years