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Endoscopy 2014; 46(04): 282-290
DOI: 10.1055/s-0033-1359215
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Confocal laser endomicroscopy for in vivo detection of gastric intestinal metaplasia: a randomized controlled trial

Zhen Li
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Xiu-Li Zuo
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Tao Yu
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Xiao-Meng Gu
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Cheng-Jun Zhou
2   Department of Pathology, the Second Affiliated Hospital, Shandong University, Jinan, China
,
Chang-Qing Li
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Rui Ji
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Yan-Qing Li
1   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
› Author Affiliations
Further Information

Publication History

submitted 14 June 2013

accepted after revision 19 November 2013

Publication Date:
28 January 2014 (online)

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Commentaire de travail de Li et al., pp. 282Endoscopy 2014; 46(04): 371-371
DOI: 10.1055/s-0034-1367545

Background and study aims: Gastric intestinal metaplasia (GIM) is associated with a risk for development of intestinal-type gastric cancer. This study aimed to compare the diagnostic yield of GIM from confocal laser endomicroscopy (CLE) and white light endoscopy (WLE).

Patients and methods: In a prospective, double-blind, randomized study, patients were randomly assigned to receive either CLE with targeted biopsies (group A) or WLE with a standard biopsy protocol (group B).

Results: A total of 168 patients were finally analyzed (group A 85, group B 83). On a per-patient analysis, the diagnostic yields of GIM (including GIM with gastric intraepithelial neoplasia [GIN]) for groups A and B were 44.71 % and 31.33 %, respectively (P = 0.074). On a per-biopsy analysis, CLE-targeted biopsy gave a significantly higher diagnostic yield of GIM compared with WLE and standard biopsy, at 65.70 % (113 /172 biopsies) versus 15.73 % (81 /515 biopsies) (P < 0.001). Moreover, the diagnostic yield of the operative link on gastric intestinal metaplasia (OLGIM) assessment stages III and IV was higher at 20.93 % (36 /172 biopsies) in group A versus 4.08 % (21 /515 biopsies) in group B (P < 0.001). In addition, use of CLE-guided biopsy significantly decreased by 68 % (P < 0.001) the mean number of biopsies required per patient.

Conclusions: CLE with targeted biopsies is superior to WLE with standard biopsies for the detection and surveillance of GIM. The number of biopsies needed to confirm GIM is about one third of that needed with WLE with standard biopsies.

 

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