Narrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial

doi:10.1016/j.gie.2017.03.1528

Gastrointestinal Endoscopy

Volume 86, Issue 5, November 2017, Pages 857-865

Presented at Digestive Disease Week, May 21-24, 2016, San Diego, CA, and at United European Gastroenterology Week, October 24-28, 2015, Barcelona, Spain. (Gastrointest Endosc 2016;83:AB156)

https://doi.org/10.1016/j.gie.2017.03.1528 Get rights and content

Background and Aims

Gastric intestinal metaplasia (GIM) is a gastric cancer precursor. Narrow-band imaging (NBI) may improve detection of GIM. We compared detection of GIM with high-definition white-light (HD-WL) endoscopy, NBI, and mapping biopsies in a population with increased gastric cancer risk.

Methods

Patients undergoing upper endoscopy had HD-WL examination by 1 endoscopist, followed by an NBI examination by a second endoscopist blinded to HD-WL findings. The location of abnormalities detected by HD-WL and NBI were recorded by a research coordinator, and targeted biopsies of abnormal areas were performed after NBI. Subsequently, 5 mapping biopsies were performed per patient. Biopsy specimens were read by a pathologist blinded to mode of acquisition. The primary outcome was the proportion of patients with GIM.

Results

We enrolled 112 patients: 107 (96%) were Hispanic or Asian, and 34 (30%) had GIM. Higher proportions of patients with GIM were detected by NBI (22/34 [65%]) and mapping (26/34 [76%]) versus HD-WL (10/34 [29%]) (P < .005 for both comparisons). GIM was detected by NBI in only 6 patients and only by mapping biopsy in 10 patients; no patient had GIM detected solely by HD-WL. Higher proportions of sites with GIM also were detected with NBI (30/57 [53%]) and mapping biopsies (38/57 [67%]) than HD-WL (16/57 [28%]) (P < .005 for both comparisons). The median number of biopsies per patient with mapping biopsies (5) was significantly higher than with NBI (2) or HD-WL (1).

Conclusions

HD-WL endoscopy is insufficient for detection of GIM in patients at increased risk for gastric cancer. NBI-targeted biopsies plus mapping biopsies should be used. (Clinical trial registration number: NCT02197351.)

Section snippets

Patients

Patients were enrolled at the Los Angeles County University of Southern California Medical Center from September 2014 to May 2016, and the study was registered at Clinicaltrials.gov (NCT02197351). Written informed consent and Health Insurance Portability and Accountability Act authorization were obtained from all patients before enrollment. All authors had access to the study data and approved the final submission.

Patients undergoing upper endoscopy for standard clinical care for the following

Patients

Given the transition of our endoscopy unit from the Evis Exera II 180 series upper endoscopes to a newer system with different NBI capabilities, the study was halted after 112 patients were enrolled. The mean age was 51.9 ± 10.6 years, and 63% were female (Table 1). One hundred patients (89%) were Hispanic, 7 (6%) were Asian, and 5 (5%) were black or white. Eight patients were born in the United States (7%); the remainder originated from Mexico (63%), Central America (24%), and Asia (6%). One

Discussion

In this prospective blinded trial, we demonstrated that targeted biopsies guided by NBI or mapping biopsies had a per-patient yield more than 2-fold greater than that of targeted biopsies guided by HD-WL. Because NBI-guided biopsies and updated Sydney mapping protocol biopsies identified different patients and sites, our data suggest that these methods are best used in combination in the evaluation of patients at increased risk for gastric cancer because of country of origin and ethnicity.

Prior

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Citation Excerpt :
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: DISCLOSURE: J. Buxbaum is a consultant for Olympus. All other authors disclosed no financial relationships relevant to this publication.

: If you would like to chat with an author of this article, you may contact Dr Buxbaum at [email protected].

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Original articleClinical endoscopyNarrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial

Background and Aims

Methods

Results

Conclusions

Section snippets

Patients

Patients

Discussion

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Hum Pathol

Hum Pathol

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Clin Gastroenterol Hepatol

International Agency for Research on Cancer. World cancer report 2014

The gastric precancerous cascade

J Dig Dis

Pathology of gastric intestinal metaplasia: clinical implications

Am J Gastroenterol

Original article
Clinical endoscopy
Narrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial