Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial

doi:10.1016/j.gie.2007.06.009

Gastrointestinal Endoscopy

Volume 67, Issue 2, February 2008, Pages 210-216

https://doi.org/10.1016/j.gie.2007.06.009 Get rights and content

Background

A novel narrow band imaging (NBI) system is able to visualize the mucosal and vascular network in the GI tract.

Objective

The aim of the current study was to test the feasibility of NBI to predict gastric histologic diagnosis.

Design

A pilot feasibility study.

Setting

Veterans Affairs Medical Center.

Patients

Forty-seven patients undergoing upper endoscopy for various indications were prospectively enrolled.

Methods

The gastric body and antrum were systematically examined by NBI before targeted biopsies. Images were graded according to the mucosal (ridge/villous and circular) and vascular patterns and correlated with histologic findings in a blinded manner.

Main Outcome Measurements

Final histologic diagnosis based on updated Sydney classification system.

Results

Overall, 25 patients (53.1%) had a normal biopsy specimen, 13 (27.6%) had non–Helicobacter pylori gastritis, 4 (8.5%) had H pylori gastritis, and 5 (10.6%) had intestinal metaplasia. The sensitivity, specificity, and positive predictive value of a regular mucosal and vascular pattern for the diagnosis of normal mucosa/mild gastritis were 89%, 78%, and 94%, respectively. The sensitivity and specificity of an irregular pattern with decreased density of vessels for the diagnosis of H pylori were 75% and 88%, and that of the ridge/villous pattern for the diagnosis of intestinal metaplasia were 80% and 100%, respectively.

Limitation

The small number of patients with H pylori and intestinal metaplasia was the main limitation.

Conclusions

This is the first U.S. study of NBI for gastric lesions. NBI may help predict in vivo histologic diagnosis of gastric pathologic conditions with a good degree of accuracy. Future larger studies are needed.

Section snippets

Patients

Patients seen in the endoscopy unit of the Veterans Affairs Medical Center, Kansas City, for an upper endoscopy for various indications (reflux symptoms, dyspepsia, heme-positive stool, anemia) were recruited for this prospective study. The study protocol and consent form were approved by the Human Subjects Committee of the institution. All patients underwent a complete history and physical examination before the endoscopic procedure, and written informed consent was obtained before the study.

Patients

Forty-seven patients with a mean age of 65 years (range 43-82 years) were enrolled in this study. This included 46 men and 1 woman; 46 were white and 1 was black. None of the patients had masses, nodules, or ulcers in the stomach by standard upper endoscopy. By NBI, the mucosal and the vascular patterns could be visualized in all patients. Overall, 25 patients (53.1%) had a normal biopsy specimen, 12 (25.5%) had mild gastritis, 1 had moderate gastritis (2.1%), 4 (8.5%) had gastritis associated

Discussion

Given the shortcomings of standard upper endoscopy to accurately diagnose lesions, a number of new techniques to identify mucosal and vascular details are being evaluated, such as chromoendoscopy, optical coherence tomography, confocal microscopy, etc. NBI is one such novel system of studying the surface pattern of GI mucosa along with its vascularity. Preliminary data regarding the usefulness of NBI in identifying intestinal metaplasia and high-grade dysplasia in the esophagus,¹⁷ squamous

Acknowledgment

We thank Dr Aditi Gupta for help with the schematic diagrams and Mary Mackison for her administrative support.

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Original articleClinical endoscopyCorrelation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial

Background

Objective

Design

Setting

Patients

Methods

Main Outcome Measurements

Results

Limitation

Conclusions

Section snippets

Patients

Patients

Discussion

Acknowledgment

Gastroenterology

Mod Pathol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Dig Liver Dis

Gastrointest Endosc

Gastric and duodenal mucosa in “healthy” individuals: an endoscopic and histopathological study of 50 volunteers

J Clin Pathol

Limited value of type III intestinal metaplasia in predicting risk of gastric carcinoma

J Clin Pathol

Intestinal metaplasia and gastric carcinoma

Ann Clin Res

Intestinal metaplasia of the stomach: a status report

Cancer

Chronic gastritis: a clinico-pathological classification

Am J Gastroenterol

Campylobacter pylori–associated gastritis and immune response in a population at increased risk of gastric carcinoma

Am J Gastroenterol

Original article
Clinical endoscopy
Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial