Artículo Original 1Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile. 2Escuela de Medicina, Pontificia Universidad Católica de Chile. 3Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. 4Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile. Correspondencia a: Gonzalo Latorre S. gonzalo.latorre@ gmail.com 207 Gastroenterol. latinoam 2016; Vol 27, Nº 4: 207-214 Aumento de detección de lesiones gástricas premalignas mediante protocolo Sydney en comparación con biopsias no protocolizadas Gonzalo Latorre S.1, Matías Jiménez B., Camila Robles G.2, Elissa Jensen S. C.2, Bernardita Ramos M.2, Martín Fritzsche V.2, Jai-Sen Leung C.2, José Ignacio Vargas D.3, Diego San Martín R.3, Javiera Torres M.4, Juan Carlos Roa S.4, Hugo Monrroy B.3, Alberto Espino E.3, Robinson González D.3 y Arnoldo Riquelme P.3 Increased detection of premalignant gastric lesions through Sydney protocol in comparison with non-protocolized gastric biopsies 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. Key words: Sydney protocol, gastric premalignant lesions, gastric atrophy, gastric intestinal metaplasia, gastric cancer, upper gastrointestinal endoscopy. Resumen Introducción: El cáncer gástrico (CG) es la principal causa de muertes por cáncer en Chile. El desarrollo del adenocarcinoma gástrico es precedido por una cascada histopatológica (gastritis; atrofia gástrica/AG; metaplasia intestinal/MI). Se ha propuesto la biopsia del cuerpo, ángulo y antro a través del protocolo de Sydney para la búsqueda de estas condiciones. Objetivo: Determinar la diferencia en la detección de lesiones premalignas gástricas a través del protocolo de Sydney comparado con el estudio endoscópico habitual. Métodos: Se analizaron las endoscopias digestivas altas (EDA) realizadas en el Centro de
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