Search

Background and Aim: Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM).Methods: A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard.Results: A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98.Conclusions: In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation. [ABSTRACT FROM AUTHOR]

Background: Often early gastric cancer (EGC) is asymptomatic, that is why most of the patients come for medical investigation already ill with advanced gastric cancer. The detection of premalignant gastric lesions and their control, help the exposure of gastric cancer in its initial stage and implicitly to a prompter access to the appropriate treatment for the patients. This study quantifies the utility of narrow band imaging-endoscopy (NBI) for the detection of premalignant lesions and early gastric cancer. Material and methods: This prospective study included 63 patients. They underwent an examination with white light endoscopy (WLE) and Sidney system of biopsy followed by magnifying NBI with targeted biopsies. We monitored the presence of EGC, dysplasia (Dis), intestinal metaplasia (IM). Results: IM was diagnosed in 60 patients, and 128 areas. Dis was detected in 11 patients and 13 areas and 2 patients had EGC. The premalignant gastric lesions were detected by both investigation methods. We followed sensibility, specificity, positive, negative predictive values. For NBI we obtained 81%, 75%, and for WLE 52%, 68%. The EGC was diagnosed only with NBI. Conclusions: NBI endoscopy is better than WLE for detected IM, Dis and EGC. This method can be used for screening EGC. [ABSTRACT FROM AUTHOR]