Background and aims
The diagnosis of gastric intestinal metaplasia (GIM) is still challenging. Optical Enhancement technology (OE) may improve the detection of GIM. We compared detection of GIM with OE, acetic acid and the Sydney biopsy protocol in a surveillance population.
Consecutive patients with atrophic gastritis or known GIM were prospectively included. The stomach was examined with high definition whitelight endoscopy, followed by OE or acetic acid with targeted biopsies (1:1 randomisation). Subsequently, five random biopsies were taken according to the updated Sydney system.
A total of 154 patients were randomized. Higher proportions of patients with GIM were detected by OE and acetic acid versus random biopsy (60.5% vs 35.5%, 67.1% vs 31.5%, respectively; P < 0.0001 for both comparisons). The combined use of targeted biopsies and random biopsies provides high diagnostic yields for GIM (78.9% in OE group and 83.6% in acetic acid group). In addition, the proportion of extensive GIM was significantly increased when image enhanced endoscopy was used instead of white light endoscopy (P = 0.029, P = 0.048, respectively).
OE and acetic acid showed comparable results diagnosing GIM in the study. Targeted biopsies plus random biopsies should be used complementary in high risk populations.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.Int J Cancer. 2015; 136: E359-86
- Surveillance of patients with gastric precancerous conditions.Best Pract Res Clin Gastroenterol. 2016; 30: 913-922
- Topographic patterns of intestinal metaplasia and gastric cancer.Am J Gastroenterol. 2000; 95: 1431-1438
- Factors predicting progression of gastric intestinal metaplasia: results of a randomised trial on Helicobacter pylori eradication.Gut. 2004; 53: 1244-1249
- Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019.Endoscopy. 2019; 51: 365-388
- Classification and grading of gastritis. The updated Sydney system. International workshop on the histopathology of gastritis, Houston 1994.Am J Surg Pathol. 1996; 20: 1161-1181
- The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis.Gastrointest Endosc. 2010; 71: 1150-1158
- Acetic acid chromoendoscopy for determining the extent of gastric intestinal metaplasia.Gastrointest Endosc. 2017; 85: 349-356
- Intestinal metaplasia of the gastric cardia: a prospective study with enhanced magnification endoscopy.Am J Gastroenterol. 2002; 97: 584-589
- Beyond white light: optical enhancement in conjunction with magnification colonoscopy for the assessment of mucosal healing in ulcerative colitis.Endoscopy. 2017; 49: 553-559
- Evaluation of the diagnostic ability of optical enhancement system in early gastric cancer demarcation.Gastroenterol Res Pract. 2016; 20162439621
- A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy.Endoscopy. 2006; 38: 819-824
- A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions.Endoscopy. 2012; 44: 236-246
- Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis.Gastrointest Endosc. 2016; 83: 57-67
- Probe-based endomicroscopy for in vivo detection of gastric intestinal metaplasia and neoplasia: a multicenter randomized controlled trial.Endoscopy. 2017; 49: 1033-1042
- An Asian consensus on standards of diagnostic upper endoscopy for neoplasia.Gut. 2019; 68: 186-197
- Acetic acid compared with i-scan imaging for detecting Barrett’s esophagus: a randomized, comparative trial.Gastrointest Endosc. 2014; 79: 46-54
- Comparison of computed virtual chromoendoscopy and conventional chromoendoscopy with acetic acid for detection of neoplasia in Barrett’s esophagus.Endoscopy. 2007; 39: 594-598
- A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions.Endoscopy. 2016; 48: 723-730
- A multicenter randomized comparison between high-definition white light endoscopy and narrow band imaging for detection of gastric lesions.Eur J Gastroenterol Hepatol. 2015; 27: 1473-1478
- Narrow band imaging versus white light gastroscopy in detecting potentially premalignant gastric lesions: a randomized prospective crossover study.Indian J Gastroenterol. 2013; 32: 37-42
- Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology.Dig Endosc. 2014; 26: 43-51
- Linked color imaging and blue laser imaging for upper gastrointestinal screening.Clin Endosc. 2018; 51: 513-526
- Narrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial.Gastrointest Endosc. 2017; 86: 857-865
- Pathology of gastric intestinal metaplasia: clinical implications.Am J Gastroenterol. 2010; 105: 493-498
Published online: April 04, 2020
Accepted: February 17, 2020
Received: August 11, 2019
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.