Background and study aims: With endoscopy, there is a high rate of interobserver variability in the identification
of gastric intestinal metaplasia, and the endoscopic findings correlate poorly with
the histological findings. Previous studies by our group investigating the use of
a narrow-band imaging system with magnifying endoscopy (NBI-ME) in the gastric mucosa
suggested that the appearance of a light blue crest (LBC) on the epithelial surface
may be a distinctive endoscopic finding associated with the presence of intestinal
metaplasia. The aim of the present study was to clarify the value of NBI-ME for diagnosing
gastric intestinal metaplasia.
Patients and methods: The LBC was defined as a fine, blue-white line on the crests of the epithelial surface/gyri.
To investigate the histology underlying the appearance of LBC, 44 biopsy specimens
were obtained from regions containing LBC and 44 from non-LBC mucosa in 34 patients
with atrophic gastritis. Three endoscopists then carried out NBI-ME in 107 consecutive
patients to validate the diagnostic accuracy of the novel endoscopic technique. The
degree of correlation between the LBC grading and the histological parameters of intestinal
metaplasia was then assessed.
Results: The LBC grading correlated with cells that were positive for CD10 (P = 0.0001) and Alcian blue (P = 0.036). The appearance of LBC correlated with histological evidence of intestinal
metaplasia with a sensitivity of 89 % (95 % CI, 83 - 96 %), a specificity of 93 %
(95 % CI, 88 - 97 %), a positive predictive value of 91 % (95 % CI, 85 - 96 %), a
negative predictive value of 92 % (95 % CI, 87 - 97 %), and an accuracy of 91 % (95
% CI, 88 - 95 %).
Conclusions: In narrow-band imaging with magnifying endoscopy, observation of a light blue crest
on the epithelial surface in the gastric mucosa is a highly accurate sign of the presence
of histological intestinal metaplasia.
References
1
Sauerbruch T, Schreiber M A, Schüssler P, Permanetter W.
Endoscopy in the diagnosis of gastritis: diagnostic value of endoscopic criteria in
relation to histological diagnosis.
Endoscopy.
1984;
16
101-104
2
Gono K, Obi T, Yamaguchi M. et al .
Appearance of enhanced tissue features in narrow-band endoscopic imaging.
J Biomed Opt.
2004;
9
568-577
3
Nakayoshi T, Tajiri H, Matsuda K. et al .
Magnifying endoscopy combined with narrow band imaging system for early gastric cancer:
correlation of vascular pattern with histopathology (including video).
Endoscopy.
2004;
36
1080-1084
4
Machida H, Sano Y, Hamamoto Y. et al .
Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.
Endoscopy.
2004;
36
1094-1098
5
Uedo N, Ishihara R, Iishi H. et al .
New diagnostic modality of gastric intestinal metaplasia: narrow band imaging system
with magnifying endoscopy [abstract].
Gastrointest Endosc.
2005;
61
AB184
6
Kabashima A, Yao T, Sugimachi K, Tsuneyoshi M.
Gastric or intestinal phenotypic expression in the carcinomas and background mucosa
of multiple early gastric carcinomas.
Histopathology.
2000;
37
513-522
7
Filipe M I, Barbatis C, Sandey A, Ma J.
Expression of intestinal mucin antigens in the gastric epithelium and its relationship
with malignancy.
Hum Pathol.
1988;
19
19-26
8
Dixon M F, Genta R M, Yardley J H, Correa P.
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
9
Kaminishi M, Yamaguchi H, Nomura S. et al .
Endoscopic classification of chronic gastritis based on a pilot study by the Research
Society for Gastritis.
Dig Endosc.
2002;
14
138-151
10
Dinis-Ribeiro D M, da Costa-Pereira C, Lopes C. et al .
Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and
dysplasia.
Gastrointest Endosc.
2003;
57
498-504
11
Tatsuta M, Iishi H, Ichii M. et al .
Chromoendoscopic observations on extension and development of fundal gastritis and
intestinal metaplasia.
Gastroenterology.
1985;
88
70-74
12
Olliver J R, Wild C P, Sahay P. et al .
Chromoendoscopy with methylene blue and associated DNA damage in Barrett’s oesophagus.
Lancet.
2003;
362
373-374
13
Groisman G M, Amar M, Livne E.
CD10: a valuable tool for the light microscopic diagnosis of microvillous inclusion
disease (familial microvillous atrophy).
Am J Surg Pathol.
2002;
26
902-907
14
Carl-McGrath S, Lendeckel U, Ebert M. et al .
The ectopeptidases CD10, CD13, CD26, and CD143 are upregulated in gastric cancer.
Int J Oncol.
2004;
25
1223-1232
N. Uedo, M. D.
Dept. of Gastrointestinal Oncology
Osaka Medical Center for Cancer and Cardiovascular Diseases · 3 - 3 Nakamichi 1-chome,
Higashinari-ku · Osaka 537-8511 · Japan
Fax: +81-6-6981-4067·
eMail: uedou-no@mc.pref.osaka.jp