Endoscopic Kyoto and Kimura-Takemoto Classifications Are Comparable in Predicting High-Risk Gastric Precancerous Lesions

<b><i>Introduction:</i></b> Severe and extensive gastric atrophy, extensive or incomplete gastric intestinal metaplasia, and gastric dysplasia are considered high-risk gastric precancerous lesions (HGPLs). Endoscopic findings based on the endoscopic Kyoto classification (EKC) and the Kimura-Takemoto classification (KTC) have been reported to be significantly associated with HGPLs. This study aimed to compare these two classifications in predicting active <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection and HGPLs. <b><i>Methods:</i></b> This is a cross-sectional study conducted on naïve dyspeptic patients who underwent upper gastrointestinal endoscopy at a tertiary hospital. Endoscopic findings were scored according to the EKC and KTC. Mapping biopsies were taken, and <i>H. pylori</i> infection was determined using a locally validated rapid urease test and histology. The performance of EKC was compared with that of KTC using the area under the receiver operating characteristic curve (AUC) in predicting active <i>H. pylori</i> infection and HGPLs. <b><i>Results:</i></b> There were 292 patients with a median age of 46 and a male-to-female ratio of 1:1. The rates of active <i>H. pylori</i> infection and HGPLs were 61.3% and 14.0%, respectively. The EKC was better than the KTC in predicting active <i>H. pylori</i> infection (AUC: 0.771 vs. 0.658, respectively; <i>p</i> &lt; 0.001). However, these two classifications had comparable performance in predicting HGPLs (AUC: 0.792 vs. 0.791, respectively; <i>p</i> = 0.956). <b><i>Conclusion:</i></b> Compared to EKC, KTC is inferior in predicting active <i>H. pylori</i> infection but has comparable performance in predicting HGPLs.