Extending magnifying NBI diagnosis of intestinal metaplasia in the stomach: the white opaque substance marker

Abstract

Intestinal metaplasia (IM) of the stomach is associated with an increased risk of differentiated gastric cancer. While it is important to diagnose IM endoscopically, it can be difficult to observe by white-light endoscopy. In magnifying endoscopy with narrow-band imaging (M-NBI) of the stomach, a light-blue crest (LBC) is widely known to be a useful marker in the endoscopic diagnosis of IM. However, IM that exhibits only white opaque substance (WOS) without an LBC can also occur. The aim of this study was to elucidate whether the presence of WOS on M-NBI of the stomach could serve as a marker of IM in the same way that an LBC does. The subjects were 40 consecutive patients who underwent M-NBI between July and December 2014. The primary endpoint in this study was to evaluatethe diagnostic performance of M-NBI for histologically observed IM in WOS- and LBC-positive mucosa. The sensitivity and specificity of WOS for histologically diagnosed IM were 50.0 % (95 % confidence interval [CI] 40.0 % - 50.0 %) and 100.0 % (95 %CI 85.0 % - 100.0 %), respectively. Meanwhile, the sensitivity and specificity of LBC were 62.5 % (95 %CI 51.1 % - 65.9 %) and 93.8 % (95 %CI 76.7 % - 98.9 %), respectively. The sensitivity and specificity of WOS and/or LBC (WOS positive and LBC positive, WOS positive and LBC negative, or WOS negative and LBC positive) for histologically diagnosed IM were 87.5 % (95 %CI 76.9 % - 90.9 %) and 93.8 % (95 %CI 77.9 % - 98.9 %), respectively. LBC and WOS are both useful markers for endoscopic diagnosis of IM. Combining both markers improves the sensitivity.Clinical trial number: UMINCTR000014453.

Lavender Color in Linked Color Imaging Enables Noninvasive Detection of Gastric Intestinal Metaplasia

“…Our data showed that LCS using LCI had slightly higher diagnostic accuracy for GIM than that shown in a recent report for NBI [10]. LCI enables the detection of not only bluish-whitish patchy areas in NBI as LCS but also GIM as mottled patchy erythema and map-like redness, which typically appear after H. pylori eradication in patients with severe atrophy [25,26].…”

“…Uedo et al [8] reported that the sensitivity and specificity of LBC as a predictor of GIM were 89 and 93%, respectively, and Kanemitsu et al [10] reported that those of white opaque substance were 50 and 100% respectively. Although GIM is observed as bluish-whitish patchy areas in the antrum using NBI without magnification, a meta-analysis of the diagnosis of GIM using NBI without magnification showed that the sensitivity and specificity were 0.69 and 0.91 respectively [12].…”

“…Some specific magnifying endoscopic findings such as light blue crest (LBC) and white opaque substance with narrow band imaging (NBI) have been shown to be useful for optical di- agnosis of GIM. However, image-enhanced endoscopy has not been the standard for diagnosis of GIM [8][9][10][11][12].…”

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

“…On the other hand, dysplasia or cancer may present as a “white opaque substance,” which, as the name implies, is characterized by white material above the mucosa [10, 31, 33, 34]. However, a white opaque substance has also been associated with intestinal metaplasia, so it is not a specific marker [39]. …”

“…ME-NBI has also been proven useful in the diagnosis of early gastric cancer, and the Magnifying Endoscopy Simple Diagnostic Algorithm for Early Gastric Cancer (MESDA-G) was recommended for the evaluation of a suspicious gastric lesion [39]. It applies the Vessels plus Surface Classification and suggests evaluation with NBI if a clear border between the suspicious lesion and the background mucosa (demarcation line) exists: if absent, it excludes cancer; if present, microvascular and microsurface patterns should be evaluated.…”