We read with great interest the article by Lee et al 1 evaluating the risk of progression from chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) to high-grade dysplasia (HGD) or gastric adenocarcinoma (GA), according to the Operative Link on Gastric Intestinal Metaplasia (OLGIM) staging system. Patients with OLGIM III–IV had a substantially increased risk of HGD/GA, with a median time to progression of 22.7 months, while patients with OLGIM II had an intermediate risk. These findings complement the results by Rugge et al, 2 demonstrating a higher risk of neoplastic progression among patients with Operative Link on Gastritis Assessment (OLGA) III–IV, but not OLGA II.

Studies directly comparing the predictive value of both OLGA and OLGIM systems in the same cohort are scarce.3 4 We leveraged the ‘Endoscopic Cohort and Histological OLGA staging’ (trial: NCT05969444) to compare the predictive capability of OLGA versus OLGIM for HGD/GA. We included 685 Chilean adults who underwent an oesophagogastroduodenoscopy with gastric mapping biopsies, and who subsequently had at least one endoscopic surveillance examination with mapping biopsies completed at least 6 months apart (table 1). The primary outcome was histologically confirmed incident HGD or GA according to baseline OLGA and OLGIM stages (assessed by two experienced pathologists). The kappa values for interpathologist and intrapathologist agreement were 0.63 and 0.71 for …