Real-time diagnostic yield of white light endoscopy, chromoendoscopy and magnifying endoscopy with narrow band imaging in the undiagnosed gastric lesions after Helicobacter pylori eradication

Abstract

Background: Early-stage gastric cancer (EGC) after Helicobacter pylori (H. pylori) often confuse endoscopic diagnosis. We prospectively evaluated the real-time diagnostic yield of combining white light endoscopy (WLE), chromoendoscopy (CE), and magnifying endoscopy with narrow band imaging (ME-NBI) for undiagnosed gastric lesions after H. pylori eradication. Methods: Using a retrospective data set, we conducted a consensus meeting to learn ME-NBI features of EGC after H. pylori eradication associated with diagnostic difficulty. Then, we prospectively evaluated the real-time diagnostic yield of WL, followed by CE, and ME-NBI in the diagnosis of 166 newly identified gastric lesions from 219 patients after H. pylori eradication. Results: A consensus meeting characterized ME-NBI feature of EGC with diagnostic difficulty, as having irregular vessel patterns in only tiny area of the lesion. Among 166 undiagnosed gastric lesions in the prospective study, 22 neoplastic lesions (18 adenocarcinomas and 4 adenomas) were identified. In these lesions, diagnosed case was dramatically increased when combined with ME-NBI (98%) compared to WLE alone (54%) and CE with WLE (63%) (WLE+CE+ME-NBI vs. others, all P<0.0001). In the diagnosed cases, the diagnostic accuracy was also improved when combined with ME-NBI (99.4%) compared to WLE alone (92.2%: P=0.004) and CE with WLE (95.1%: P=0.03). Conclusions: WLE combined with ME-NBI can improve the diagnostic yield of EGC in patients after H. pylori eradication. For precise diagnosis of EGC by ME-NBI, it is essential to detect irregular vessels.

Indicadores de calidad en endoscopia superior: preparación, cromoendoscopia vital, digital

“…Con el uso de NBI se ha logrado desarrollar y validar una nueva clasificación para la atrofia vellosa en pacientes con sospecha de enfermedad celiaca 12 , incluso el uso de NBI sin magnificación puede incrementar el promedio de detección de metaplasia intestinal, comparado con la evaluación con luz blanca convencional 13 . Así como el diagnóstico de cáncer gástrico temprano en pacientes en quienes se ha erradicado el Helicobacter pylori 14 .…”