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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.

 

  • References

  • 1 Correa P. The biological model of gastric carcinogenesis. IARC Sci Publ 2004; 301-310
    PubMedSearch in Google Scholar
  • 2 Walker MM. Is intestinal metaplasia of the stomach reversible?. Gut 2003; 52: 1-4
    CrossrefPubMedSearch in Google Scholar
  • 3 Sauerbruch T, Schreiber MA, Schüssler P et al. Endoscopy in the diagnosis of gastritis: diagnostic value of endoscopic criteria in relation to histological diagnosis. Endoscopy 1984; 16: 101-104
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Redeen S, Petersson F, Jonsson KA et al. Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample. Endoscopy 2003; 35: 946-950
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 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
    PubMedSearch in Google Scholar
  • 6 El-Zimaity HM, Graham DY. Evaluation of gastric mucosal biopsy site and number for identification of Helicobacter pylori or intestinal metaplasia: role of the Sydney System. Hum Pathol 1999; 30: 72-77
    CrossrefPubMedSearch in Google Scholar
  • 7 Dinis-Ribeiro M, da Costa-Pereira A, Lopes C et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc 2003; 57: 498-504
    CrossrefPubMedSearch in Google Scholar
  • 8 Areia M, Amaro P, Dinis-Ribeiro M et al. External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions. Gastrointest Endosc 2008; 67: 1011-1018
    CrossrefPubMedSearch in Google Scholar
  • 9 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 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
  • 11 Olliver JR, Wild CP, Sahay P et al. Chromoendoscopy with methylene blue and associated DNA damage in Barrett's oesophagus. Lancet 2003; 362: 373-374
    CrossrefPubMedSearch in Google Scholar
  • 12 Kiesslich R, Goetz M, Vieth M et al. Confocal laser endomicroscopy. Gastrointest Endosc Clin North Am 2005; 15: 715-731
    CrossrefPubMedSearch in Google Scholar
  • 13 Guo YT, Li YQ, Yu T et al. Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study. Endoscopy 2008; 40: 547-553
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Lim LG, Yeoh KG, Salto-Tellez M et al. Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointest Endosc 2011; 73: 1141-1147
    CrossrefPubMedSearch in Google Scholar
  • 15 Dunbar KB, Okolo 3rd P, Montgomery E et al. Confocal laser endomicroscopy in Barrett’s esophagus and endoscopically inapparent Barrett’s neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. Gastrointest Endosc 2009; 70: 645-654
    CrossrefPubMedSearch in Google Scholar
  • 16 Hurlstone DP, Kiesslich R, Thomson M et al. Confocal chromoscopic endomicroscopy is superior to chromoscopy alone for the detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis. Gut 2008; 57: 196-204
    CrossrefPubMedSearch in Google Scholar
  • 17 Kato M, Kaise M, Yonezawa J et al. Autofluorescence endoscopy versus conventional white light endoscopy for the detection of superficial gastric neoplasia: a prospective comparative study. Endoscopy 2007; 39: 937-941
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: 3-43
    CrossrefPubMedSearch in Google Scholar
  • 19 Li Z, Yu T, Zuo XL et al. Confocal laser endomicroscopy for in vivo diagnosis of gastric intraepithelial neoplasia: a feasibility study. Gastrointest Endosc 2010; 72: 1146-1153
    CrossrefPubMedSearch in Google Scholar
  • 20 Li WB, Zuo XL, Li CQ et al. Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions. Gut 2011; 60: 299-306
    CrossrefPubMedSearch in Google Scholar
  • 21 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
    CrossrefPubMedSearch in Google Scholar
  • 22 Moher D, Schulz KF, Altman D. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 2001; 285: 1987-1991
    CrossrefPubMedSearch in Google Scholar
  • 23 Rugge M, Correa P, Dixon MF et al. Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading. Aliment Pharmacol Ther 2002; 16: 1249-1259
    CrossrefPubMedSearch in Google Scholar
  • 24 de Vries AC, van Grieken NC, Looman CW et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology 2008; 134: 945-952
    CrossrefPubMedSearch in Google Scholar
  • 25 Whiting JL, Sigurdsson A, Rowlands DC et al. The long term results of endoscopic surveillance of premalignant gastric lesions. Gut 2002; 50: 378-381
    CrossrefPubMedSearch in Google Scholar
  • 26 Rugge M, Genta RM. Staging gastritis: an international proposal. Gastroenterology 2005; 129: 1807-1808
    CrossrefPubMedSearch in Google Scholar
  • 27 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
  • 28 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 Gastrointest Endosc (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
  • 29 Cassaro M, Rugge M, Gutierrez O et al. Topographic patterns of intestinal metaplasia and gastric cancer. Am J Gastroenterol 2000; 95: 1431-1438
    CrossrefPubMedSearch in Google Scholar
  • 30 Kiesslich R, Gossner L, Goetz M et al. In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol 2006; 4: 979-987
    CrossrefPubMedSearch in Google Scholar
  • 31 Goetz M, Dunbar KB, Canto MI. Examination technique of confocal laser endomicroscopy. In: Kiesslich R, Galle PR, Neurath MF, eds. Atlas of endomicroscopy. Berlin: Springer-Heidelberg; 2008: 34
    Search in Google Scholar