Ultra-magnifying narrow-band imaging for endoscopic diagnosis of gastric intestinal metaplasia: a pilot image analysis study

Abstract

Background and study aims Narrow-band imaging (NBI) with or without magnification has recently been used for diagnosis of gastric intestinal metaplasia (GIM). Endocytoscopy is a newly developed endoscopic technique that enables ultra-high (500 ×) magnification of the digestive tract mucosa. This study aimed to analyze the ultra-magnifying NBI characteristics of GIM.

Patients and methods This was a retrospective observational study conducted in a cancer referral center. Patients who underwent ultra-magnifying NBI of the gastric mucosa using endocytoscopy were eligible. A soft black cap was used for non-contact observation. We compared the characteristic findings of GIM by ultra-magnifying NBI of metaplastic and non-metaplastic mucosae. A reference standard for GIM in this study was conventional magnifying NBI findings of GIM.

Results We obtained 28 images of metaplastic mucosa and 32 of non-metaplastic mucosa from 38 patients. Ultra-magnifying NBI revealed the cobblestone-like cellular structure in the marginal crypt epithelium of metaplastic and non-metaplastic mucosa. Diagnostic values (sensitivity, specificity, accuracy and kappa value [95 % confidence interval]) for the heterogeneous cellular structure and rough contour of the marginal crypt epithelium were 82 % (68 %–96 %), 94 % (85 %–100 %), 88 % (80 %–96 %), and 0.70, and 86 % (73 %–99 %), 94 % (85 %–100 %), 90 % (82 %–98 %), and 0.71, respectively.

Conclusions The characteristic ultrastructural features of GIM were identified by ultra-magnifying NBI, warranting validation of diagnostic value in a prospective study.

Publikationsverlauf

Eingereicht: 10. Mai 2020

Angenommen: 24. November 2020

Artikel online veröffentlicht:
17. März 2021

• References

• 1 Lage J, Uedo N, Dinis-Ribeiro M. et al. Surveillance of patients with gastric precancerous conditions. Best Pract Res Clin Gastroenterol 2016; 30: 913-922
• 2 Pimentel-Nunes P, Libânio D, Marcos-Pinto R. et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy 2019; 51: 365-388
• 3 Dixon MF, Genta RM, Yardley JH. et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181
• 4 Capelle LG, de Vries AC, Haringsma J. et al. The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis. Gastrointest Endosc 2010; 71: 1150-1158
• 5 Uedo N, Ishihara R, Iishi H. et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy 2006; 38: 819-824
• 6 Pimentel-Nunes P, Libânio D, Lage J. et al. A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions. Endoscopy 2016; 48: 723-730
• 7 Esposito G, Pimentel-Nunes P, Angeletti S. et al. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy 2019; 51: 515-521
• 8 Inoue H, Sasajima K, Kaga M. et al. Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial. Endoscopy 2006; 38: 891-895
• 9 Yao K, Nagahama T, Matsui T. Magnification endoscopy technique based on gastric microvascular architecture. Gastroenterological Endosc 2008; 50: 1145-1153
• 10 An JK, Song GA, Kim GH. et al. Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia. BMC Gastroenterol 2012; 12: 169
• 11 Kanemitsu T, Yao K, Nagahama T. et al. Extending magnifying NBI diagnosis of intestinal metaplasia in the stomach: the white opaque substance marker. Endoscopy 2017; 49: 529-535
• 12 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
• 13 Kumagai Y, Monma K, Kawada K. Magnifying chromoendoscopy of the esophagus: in-vivo pathological diagnosis using an endocytoscopy system. Endoscopy 2004; 36: 590-594
• 14 Inoue H, Sasajima K, Kaga M. et al. Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial. Endoscopy 2006; 38: 891-895
• 15 Kudo SE, Wakamura K, Ikehara N. et al. Diagnosis of colorectal lesions with a novel endocytoscopic classification-a pilot study. Endoscopy 2011; 43: 869-875
• 16 Minami H, Inoue H, Yokoyama A. et al. Recent advancement of observing living cells in the esophagus using CM double staining: endocytoscopic atypia classification. Dis Esophagus 2012; 25: 235-241
• 17 Kodashima S, Fujishiro M, Takubo K. et al. Ex-vivo study of high-magnification chromoendoscopy in the gastrointestinal tract to determine the optimal staining conditions for endocytoscopy. Endoscopy 2006; 38: 1115-1121
• 18 Ichimasa K, Kudo SE, Mori Y. et al. Double staining with crystal violet and methylene blue is appropriate for colonic endocytoscopy: an in vivo prospective pilot study. Dig Endosc 2014; 26: 403-408
• 19 Kaise M, Ohkura Y, Iizuka T. et al. Endocytoscopy is a promising modality with high diagnostic accuracy for gastric cancer. Endoscopy 2015; 47: 19-25
• 20 Kataoka S, Kudo SE, Misawa M. et al. Endocytoscopy with NBI has the potential to correctly diagnose diminutive colorectal polyps that are difficult to diagnose using conventional NBI. Endosc Int Open 2020; 8: E360-E367
• 21 Nakamura H, Kudo SE, Misawa M. et al. Evaluation of microvascular findings of deeply invasive colorectal cancer by endocytoscopy with narrow-band imaging. Endosc Int Open 2016; 4: E1280-E1285
• 22 Takeda K, Kudo SE, Misawa M. et al. Comparison of the endocytoscopic and clinicopathologic features of colorectal neoplasms. Endosc Int Open 2016; 4: E397-E402
• 23 Winborn WB, Weser E. Scanning electron microscopy of intestinal metaplasia of the human stomach. Gastrointest Endosc 1983; 29: 201-207
• 24 Takagi T, Takebayashi S, Tokuyasu K. et al. Scanning electron microscopy on the human gastric mucosa; fetal, normal and various pathological conditions. Acta Pathol Jpn 1974; 24: 233-247
• 25 Fallah E, Schuman BM, Watson JH. et al. Scanning electron microscopy of gastroscopic biopsies. Gastrointest Endosc 1976; 22: 137-144
• 26 Chiu PW, Ng EK, To KF. et al. Recognition of goblet cells upon endocytoscopy indicates the presence of gastric intestinal metaplasia. Dig Endosc 2014; 26: 52-56
• 27 Yao K, Iwashita A, Nambu M. et al. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Dig Endosc 2012; 24: 419-425
• 28 Saka A, Yagi K, Nimura S. OLGA- and OLGIM-based staging of gastritis using narrow-band imaging magnifying endoscopy. Dig Endosc 2015; 27: 734-741
• 29 Wang L, Huang W, Du J. et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia: a meta-analysis. PLoS One 2014; 9: e92874