Comparison of white-light endoscopy, optical-enhanced and acetic-acid magnifying endoscopy for detecting gastric intestinal metaplasia: A randomized trial

Abstract

BACKGROUND Gastric intestinal metaplasia (GIM) is a precancerous lesion of the stomach, which severely affects human life and health. Currently, a variety of endoscopic techniques are used to screen/evaluate GIM. Traditional white-light endoscopy (WLE) and acetic-acid chromoendoscopy combined with magnifying endoscopy (ME-AAC) are the interventions of choice due to their diagnostic efficacy for GIM. Optical-enhanced magnifying endoscopy (ME-OE) is a new virtual chromoendoscopy technique to identify GIM, which combines bandwidth-limited light and image enhancement processing technology to enhance the detection of mucosal and vascular details. We hypothesized that ME-OE is superior to WLE and ME-AAC in the evaluation of GIM. AIM To directly compare the diagnostic value of WLE, ME-AAC, and ME-OE for detection of GIM. METHODS A total of 156 patients were subjected to consecutive upper gastrointestinal endoscopy examinations using WLE, ME-AAC, and ME-OE. Histopathological findings were utilized as the reference standard. Accuracy, sensitivity, specificity, and positive and negative predictive values of the three endoscopy methods in the diagnosis of GIM were evaluated. Moreover, the time to diagnosis with ME-AAC and ME-OE was analyzed. Two experts and two non-experts evaluated the GIM images diagnosed using ME-OE, and diagnostic accuracy and intra- and inter-observer agreement were analyzed. RESULTS GIM was detected in 68 of 156 patients (43.6%). The accuracy of ME-OE was highest (91.7%), followed by ME-AAC (86.5%), while that of WLE (51.9%) was lowest. Per-site analysis showed that the overall diagnostic accuracy of ME-OE was higher than that of ME-AAC ( P = 0.011) and WLE ( P < 0.001). The average diagnosis time was lower in ME-OE than in ME-AAC (64 ± 7 s vs 151 ± 30 s, P < 0.001). Finally, the inter-observer agreement was strong for both experts ( k = 0.862) and non-experts ( k = 0.800). The internal consistency was strong for experts ( k = 0.713, k = 0.724) and moderate for non-experts ( k = 0.667, k = 0.598). CONCLUSION For endoscopists, especially experienced endoscopists, ME-OE is an efficient, convenient, and time-saving endoscopic technique that should be used for the diagnosis of GIM.

Role of Endoscopy in Management of Upper Gastrointestinal Cancers

“…Evaluation for GIM is performed via biopsy of mucosal lesions and gastric mapping per the Sydney protocol [ 29 ], which involves taking biopsies from the greater and lesser curvatures of the body and antrum, and from the incisura [ 27 ]. Techniques such as narrow band imaging and chromoendoscopy have been shown to improve diagnostic yield compared to white light endoscopy alone [ 27 , 30 , 31 , 32 ].…”

Improved gastrointestinal endoscopic imaging using spectral color estimation

“…Although useful for general imaging, broad-spectrum white light could not offer enough contrast to clearly see these intricate structures. 1 This restriction may make it more difficult to correctly diagnose some conditions, particularly those affecting the vascular network like neovascularization. These difficulties highlight how urgently endoscopic imaging techniques need to progress.…”

Ultrasensitive detection of gastric cancer biomarkers via a frequency shift-based SERS microfluidic chip

“…[4][5][6] Nevertheless, the onset of gastric cancer is insidious, and most patients have been diagnosed in advanced stages. [7][8][9][10] Although endoscopy combined with histopathological analysis is the gold standard in clinical GC diagnosis, the subjectivity of pathological diagnosis and the uncertainty of endoscopic positioning often result in the misdiagnosis of small lesions in early GC. Nowadays, multiple serum tumor biomarkers, such as carcinoembryonic antigen (CEA) and vascular endothelial growth factor (VEGF), are revealed to be relevant to GC.…”