Diagnostic Accuracy of the Endoscopic Grading of Gastric Intestinal Metaplasia for Detecting Extensive Disease: a Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: The Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) has been proposed as a real-time endoscopic tool for staging gastric intestinal metaplasia (GIM) to identify high-risk subjects for surveillance. This meta-analysis evaluated the accuracy of EGGIM for identifying extensive GIM, defined as Operative Link on Gastric Intestinal Metaplasia (OLGIM) stage III-IV. METHODS: PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov were searched through February 2026. Studies assessing EGGIM in adults undergoing upper gastrointestinal endoscopy, using histological OLGIM staging as the reference standard, were included. Pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) were calculated using a hierarchical bivariate random-effects model, with the primary analysis restricted to studies using narrow-band imaging (NBI) or blue light imaging (BLI). Subgroup analyses were conducted by imaging modality and geographic region (Eastern vs. Western). RESULTS: Of nine studies identified, seven studies comprising 1,143 patients using NBI or BLI were included in the primary pooled analysis. All applied an EGGIM cutoff of ≥5. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.84-0.95) and 0.92 (95% CI 0.89-0.94), respectively. The pooled DOR was 105.93 (95% CI 53.81-208.54), and the area under the summary receiver operating characteristic curve (AUC) was 0.96 (95% CI 0.94-0.97). In descriptive subgroup analyses, diagnostic performance appeared broadly similar across Eastern and Western subgroups and across NBI and BLI platforms, despite higher disease prevalence in Eastern studies (55% vs. 18%, p <0.001). No formal between-subgroup comparison was performed due to the limited number of studies. CONCLUSIONS: EGGIM at a cutoff of ≥5 appears to demonstrate high diagnostic accuracy for identifying extensive GIM when applied using NBI- or BLI-compatible modalities. These findings appear to support the validity of EGGIM as a real-time endoscopic tool for risk stratification of patients with gastric precancerous conditions. Further studies are warranted to confirm these findings and strengthen the evidence base.