Raquel Vicente

Introduction: The risk stratification of gastric cancer (GC) is graded by assessing well‐established precursor lesions, glandular atrophy (GA), and intestinal metaplasia (IM), resulting in both the operative link on gastritis assessment (OLGA), and intestinal metaplasia (OLGIM) systems. Although the OLGIM stage is reproducible among pathologists, the OLGA system is laborious to calculate and has poor reproducibility. In addition, it does not comprehensively address the severity of both GA and IM as recommended by the Sydney consensus. We aimed to propose the Operative Link on Gastric Intestinal Metaplasia and Glandular Atrophy Assessment (OLGIMA) system, which identifies OLGIM III–IV and upstages 0–II with advanced GA. Methods: A cross‐sectional study of consecutive diagnostic gastroscopies in adults was designed. Systematic gastric biopsies were taken. The updated Sydney guidelines were used for histological grading of GA and IM. Higher GC risk was defined as OLGIM III–IV and advanced GA. Results: The OLGIMA stage was assessed based on the most severe GA and/or IM findings in both antrum and corpus. We included 998 patients (median age 57; 64% women; 35% Helicobacter pylori infection). Thirty‐nine (3.9%) patients had higher GC risk: 17 (1.7%) with OLGIM III–IV; 12 (1.2%) with advanced GA, and 10 (1%) meeting both criteria. Among OLGIM 0‐II, 12 (1.2%) patients had advanced GA. The OLGIMA system upstaged 39 (3.9%) patients to III–IV, being more sensitive than OLGIM. Conclusions: The new OLGIMA system identifies patients at higher GC risk (OLGIMA III–IV), encompassing all OLGIM III–IV patients, and upstaging those OLGIM 0–II with advanced GA. This approach addresses the OLGA and OLGIM limitations by integrating GA and IM severity as recommended by the Updated Sydney consensus.