Is Taking Routine Biopsy from Incisura Angularis During Gastroscopy Necessary?

INTRODUCTION: The updated Sydney system recommends sites and numbers of stomach biopsies (mapping) for evaluation of Helicobacter pylorii colonization, glandular atrophy, intestinal metaplasia (IM), gastrit ulcer, and cancer. The incisura angularis is considered to be a typical site for early detection of premalingnant lesions. Our study aimed to clarify whether it is necessary to take biopsy from the incisura angularis routinely during gastrocopy in addition to corpus and antrum biopsies.
METHODS: Nine hundred ninety-eight patients, with a mean age±SD of 51.13±15.2 were enrolled. Two biopsies had been taken from antrum, two from corpus, and one from incisura angularis during routine gastroscopy. Biopsy samples were taken from the stomach mucosa with non-visible detectable lesions. Histologic specimens were graded using the updated Sdyney classification.
RESULTS: H. Pylori was identified in 464 (46%) of the 998 patients. Two hundred and fifty-four (25%) patients of the 998 showed IM and 73 (7%) patients of the 998 showed atrophic gastritis. Of the 998 patients 15 (1.5%) showed H. pylorii positive in the angulus biopsy only. Similary, IM in 24 patients (2.4%) and atrophy in 15 patients (1.5%) were showed in the incisura angularis. Severe glandular atrophy score in the incisura was higher than the antrum and corpus.
DISCUSSION AND CONCLUSION: Based on our study, taking routine biopsies from incisura angularis provides little additional information; however, angulus biopsies are significant to detect severe premalignant lesion especially in high-risk patients.