Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia

Abstract

AIM:To evaluate the efficacy of non-sequential narrow band imaging (NBI) for a better recognition of gastric intestinal metaplasia (GIM). METHODS:Previously diagnosed GIM patients underwent targeted biopsy from areas with and without GIM, as indicated by NBI, twice at an interval of 1 year. The authors compared the endoscopic criteria such as light blue crest (LBC), villous pattern (VP), and large long crest (LLC) with standard histology. The results from two surveillance endoscopies were compared with histology results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of positive test (LR+). The number of early gastric cancer cases detected was also reported.RESULTS: NBI targeted biopsy was performed in 38 and 26 patients during the first and second surveillance endoscopies, respectively. There were 2 early gastric cancers detected in the first endoscopy. No cancer was detected from the second study. Surgical and endoscopic resections were successfully performed in each patient. Sensitivity, specificity, PPV, NPV, and LR+ of all 3 endoscopic criteria during the first/second surveillances were 78.8%/91.3%, 82.5%/89.1%, 72.8%/77.8%, 86.8%/96.1, and 4.51/8.4, respectively. LBC provided the highest LR+ over VP and LLC. CONCLUSION:Non-sequential NBI is useful for GIM targeted biopsy. LBC provides the most sensitive reading. However, the optimal duration between two surveillances requires further study.

Diagnostic Yield of the Light Blue Crest Sign in Gastric Intestinal Metaplasia: A Meta-Analysis

“…One study included in our meta-analysis followed 26/38 patients at 1-year intervals, and found that LBC under NBI-ME can be used effectively to surveil gastric IM, but did not find the optimal duration of follow-up [17]. The first European Guidelines on management of precancerous conditions and lesions in the stomach recommended that patients with extensive atrophic gastritis (AG) and/or extensive IM should be offered endoscopic surveillance every 3 years [25].…”

Correlation between Endoscopic and Histological Diagnoses of Gastric Intestinal Metaplasia

“…One study used NBI for targeted biopsy and surveillance of gastric IM and reported that the sensitivity and specificity of first/second surveillances are 78.8%/91.3% and 82.5%/89.1%, respectively 33. Similarly, another study reported that NBI increases the diagnostic yield for the detection of IM and dysplasia, and showed that the sensitivity and specificity of NBI were 71% and 58%, respectively 34.…”

Flexible spectral imaging color enhancement plus probe‐based confocal laser endomicroscopy for gastric intestinal metaplasia detection

“…Second, the sensitivities of each criterion for GIM diagnosis are variously suboptimal and have not been well standardized. For instance, LBC provided only 70% in sensitivity, whereas VP showed a lower sensitivity at 30% . Therefore, a combination of criteria are required to improve the sensitivity; however, this in turn may result in a lower specificity .…”

“…Over the last decade, digital chromoendoscopy (DC), including narrow band imaging (NBI), i‐scan, and flexible spectral imaging color enhancement (FICE), has been developed to diagnose EGC. Although the accuracies (70–95%) of DC for EGC and GIM detection are comparable, the interobserver agreement for GIM detection using DC remains suboptimal (κ = 0.49) . Moreover, a certain length of training is necessary for inexperienced endoscopists .…”