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Endoscopy 2016; 48(08): 723-730
DOI: 10.1055/s-0042-108435
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions

Pedro Pimentel-Nunes
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
,
Diogo Libânio
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
,
Jorge Lage
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
,
Diogo Abrantes
3   Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal
,
Miguel Coimbra
3   Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal
,
Gianluca Esposito
4   Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy
,
David Hormozdi
5   Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
,
Mike Pepper
5   Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
,
Silvia Drasovean
6   University of Medicine and Pharmacy TG., Mures, Romania
,
Jonathan R. White
7   NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
,
Daniela Dobru
6   University of Medicine and Pharmacy TG., Mures, Romania
,
James Buxbaum
5   Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
,
Krish Ragunath
7   NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
,
Bruno Annibale
4   Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy
,
Mário Dinis-Ribeiro
1   Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
2   Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
› Author Affiliations
Further Information

Publication History

submitted10 January 2016

accepted after revision17 April 2016

Publication Date:
09 June 2016 (online)

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Multiple white flat lesions in the gastric corpus are not intestinal metaplasiaEndoscopy 2017; 49(06): 615-616
DOI: 10.1055/s-0043-106434

Background and aim: Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM).

Methods: A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard.

Results: A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98.

Conclusions: In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation.

 

  • References

  • 1 Jemal A, Bray F, Center MM et al. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90
    CrossrefPubMedSearch in Google Scholar
  • 2 Leja M, You W, Camargo MC et al. Implementation of gastric cancer screening – the global experience. Best Pract Res Clin Gastroenterol 2014; 28: 1093-1106
    CrossrefPubMedSearch in Google Scholar
  • 3 Dinis-Ribeiro M, Areia M, de Vries AC et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012; 44: 74-94
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy 2012; 44: 236-246
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Kikuste I, Marques-Pereira R, Monteiro-Soares M et al. Systematic review of the diagnosis of gastric premalignant conditions and neoplasia with high-resolution endoscopic technologies. Scand J Gastroenterol 2013; 48: 1108-1117
    CrossrefPubMedSearch in Google Scholar
  • 6 Dias-Silva D, Pimentel-Nunes P, Magalhaes J et al. The learning curve for narrow-band imaging in the diagnosis of precancerous gastric lesions by using Web-based video. Gastrointest Endosc 2014; 79: 910-920 ; quiz 983 e911, 983 e914
    CrossrefPubMedSearch in Google Scholar
  • 7 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
    CrossrefPubMedSearch in Google Scholar
  • 8 Chen XY, van der Hulst RW, Bruno MJ et al. Interobserver variation in the histopathological scoring of Helicobacter pylori related gastritis. J Clin Pathol 1999; 52: 612-615
    CrossrefPubMedSearch in Google Scholar
  • 9 el-Zimaity HM, Graham DY, al-Assi MT et al. Interobserver variation in the histopathological assessment of Helicobacter pylori gastritis. Hum Pathol 1996; 27: 35-41
    CrossrefPubMedSearch in Google Scholar
  • 10 Offerhaus GJ, Price AB, Haot J et al. Observer agreement on the grading of gastric atrophy. Histopathology 1999; 34: 320-325
    CrossrefPubMedSearch in Google Scholar
  • 11 den Hoed CM, Holster IL, Capelle LG et al. Follow-up of premalignant lesions in patients at risk for progression to gastric cancer. Endoscopy 2013; 45: 249-256
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Xirouchakis E, Laoudi F, Tsartsali L et al. Screening for gastric premalignant lesions with narrow band imaging, white light and updated Sydney protocol or both?. Dig Dis Sci 2013; 58: 1084-1090
    CrossrefPubMedSearch in Google Scholar
  • 13 Capelle LG, Haringsma J, de Vries AC et al. Narrow band imaging for the detection of gastric intestinal metaplasia and dysplasia during surveillance endoscopy. Dig Dis Sci 2010; 55: 3442-3448
    CrossrefPubMedSearch in Google Scholar
  • 14 Ang TL, Pittayanon R, Lau JY et al. A multicenter randomized comparison between high-definition white light endoscopy and narrow band imaging for detection of gastric lesions. Eur J Gastroenterol Hepatol 2015; 27: 1473-1478
    CrossrefPubMedSearch in Google Scholar
  • 15 Lage J, Pimentel-Nunes P, Figueiredo PC et al. Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma: do we still need biopsies?. Scand J Gastroenterol 2016; 51: 501-506
    CrossrefPubMedSearch in Google Scholar
  • 16 Ezoe Y, Muto M, Uedo N et al. Magnifying narrowband imaging is more accurate than conventional white-light imaging in diagnosis of gastric mucosal cancer. Gastroenterology 2011; 141: 2017-2025 e2013
    CrossrefPubMedSearch in Google Scholar
  • 17 Dinis-Ribeiro M, Kuipers EJ. Identification of gastric atrophic changes: from histopathology to endoscopy. Endoscopy 2015; 47: 533-537
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Annibale B, Aprile MR, D’Ambra G et al. Cure of Helicobacter pylori infection in atrophic body gastritis patients does not improve mucosal atrophy but reduces hypergastrinemia and its related effects on body ECL-cell hyperplasia. Aliment Pharmacol Ther 2000; 14: 625-634
    CrossrefPubMedSearch in Google Scholar
  • 19 Correa P, Fontham ET, Bravo JC et al. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-Helicobacter pylori therapy. J Natl Cancer Inst 2000; 92: 1881-1888
    CrossrefPubMedSearch in Google Scholar
  • 20 De Vries AC, Kuipers EJ. Review article: Helicobacter pylori eradication for the prevention of gastric cancer. Aliment Pharmacol Ther 2007; 26 (Suppl. 02) 25-35
    CrossrefPubMedSearch in Google Scholar
  • 21 Mera R, Fontham ET, Bravo LE et al. Long term follow up of patients treated for Helicobacter pylori infection. Gut 2005; 54: 1536-1540
    CrossrefPubMedSearch in Google Scholar
  • 22 Satoh K, Kimura K, Takimoto T et al. A follow-up study of atrophic gastritis and intestinal metaplasia after eradication of Helicobacter pylori. Helicobacter 1998; 3: 236-240
    PubMedSearch in Google Scholar
  • 23 Wang J, Xu L, Shi R et al. Gastric atrophy and intestinal metaplasia before and after Helicobacter pylori eradication: a meta-analysis. Digestion 2011; 83: 253-260
    CrossrefPubMedSearch in Google Scholar