各种内窥镜活检取样方法在真实环境中检测非心性胃癌前病变的产量尚不清楚。我们的目标是评估内窥镜活检取样方法与胃肠型上皮化生（GIM）和异型增生（GD）的检测关联。我们在一个种族/民族多元的美国医疗系统中进行了一项病例对照研究，研究对象为在2010年至2021年间接受食管胃十二指肠镜检查（EGD）并进行活检的成年患者。病例组为具有GIM和/或GD组织病理学发现的患者，对照组与病例组按年龄、手术日期和医疗中心进行1:1匹配。我们比较了使用四种不同的活检取样方法检测GIM/GD的情况：未指定、指定胃部位置、二加二和悉尼方案。此外，我们评估了取样方法的使用趋势（Cochrane-Armitage）并确定与其使用相关的患者/内窥镜医生因素（逻辑回归）。我们找到了20938个GIM和455个GD配对。相对于对照组，通过二加二（31.3% vs 25.3%，p<0.0001）和悉尼方案（9.1% vs 1.0%，p<0.0001）检测到的GIM病例比例更高。同样，通过悉尼方案检测到的GD病例比例也更高（15.6% vs 0.4%，p<0.0001）。我们观察到在研究期间悉尼方案的使用呈增加趋势（病例组中从3.8%增加到16.1%，p<0.0001；对照组中从1%增加到1.1%，p=0.005）。男性和亚裔美国患者更有可能接受二加二或悉尼方案取样，而女性和西班牙裔内窥镜医生更有可能使用这些方案进行取样。在常规临床实践中，采用悉尼方案能够增加检测胃癌前病变的能力。版权所有 © 2023 美国胃肠内镜学会。Elsevier Inc. 发表。保留所有权利。

The yield of various endoscopic biopsy sampling methods for detection of precursor lesions of non-cardia gastric cancer in a real-world setting remains unclear. Our objective was to evaluate the association of endoscopic biopsy sampling methods with detection of gastric intestinal metaplasia (GIM) and dysplasia (GD).We conducted a case-control study of adult patients who underwent esophagogastroduodenoscopy (EGD) with biopsy between 2010-2021 in a racially/ethnically diverse United States healthcare system. Cases were patients with histopathologic findings of GIM and/or GD. Controls were matched 1:1 by age, procedure date, and medical center. We compared the detection of GIM/GD using four different biopsy sampling methods: unspecified, specified stomach location, two-plus-two, and Sydney protocol. Additionally, we assessed trends in use of sampling methods (Cochrane-Armitage) and identified patient/endoscopist factors associated with their use (logistic regression).We identified a total of 20,938 GIM and 455 GD matched pairs. A greater proportion of GIM-cases were detected using two-plus-two (31.3%vs25.3%, p<0.0001) and Sydney (9.1%vs1.0%, p<0.0001) compared to controls. Similarly, a greater proportion of GD-cases were detected using Sydney (15.6%vs0.4%, p<0.0001). We observed an increasing trend in the use of the Sydney protocol during the study period (3.8% to 16.1% in cases, p<0.0001; 1% to 1.1% in controls, p=0.005). Male and Asian-American patients were more likely to undergo two-plus-two or Sydney, while female and Hispanic endoscopists were more likely to perform sampling using these protocols.The application of the Sydney protocol is associated with an increased detection of precursor lesions of gastric cancer in routine clinical practice.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.