Can NBI Alone Accurately Identify GIM In a Low Risk Population Compared with Sydney Protocol? Preliminary Data From a Pilot Study In A Non-Academic Center

Aims The evaluation of Narrow Band Imaging (NBI) outside a tertiary center environment as an assessment method for Gastric Intestinal Metaplasia (GIM) when compared with the established standard of White Light Imaging (WLI) endoscopy with random, Sydney protocol biopsies.

Methods Consecutive patients undergoing upper endoscopy in Tzaneion General Hospital of Piraeus were enrolled in the study after informed consent from January to September 2020. Two different endoscopists performed gastroscopy on the same patient. Initially, NBI gastroscopy alongside targeted biopsies from suspicious GIM lesions was performed by the first endoscopist who recorded the Endoscopic Grading for GIM (EGGIM) score for staging. The second endoscopist, being blinded to the NBI findings, consequently performed WLI/Sydney protocol gastroscopy. Pathology examination was also blinded to endoscopic findings. Additionally to the abovementioned, epidemiological data were recorded while the primary outcome was GIM identification based on NBI/EGGIM score, NBI targeted or Sydney protocol biopsies. McNeamar test for paired data was used for comparison and P < 0.05 was considered statistically significant.

Results In total, 28 patients were enrolled and their demographic characteristics are depicted in [Table 1].

Tab. 1

Sex, female, n (%)	17 (60.7 %)
Age, mean	63.5
Current smoking, n (%)	8 (28.6 %)
Family history of gastric cancer, n (%)	2 (0.07 %)
Current PPI use, n (%)	9 (32,1 %)

GIM, identified in 16/28 (57.1 %) patients overall, was detected by NBI/EGGIM in 15/28 (53.6 %), by targeted biopsies in 14/28 (50 %) and by Sydney protocol in 9/28 (32.1 %) patients. There was no significant difference between GIM detected by NBI/EGGIM without targeted and by Sydney protocol biopsies (P=0.0771). GIM was detected only by Sydney protocol in one patient but missed in 7 patients at whom it was identified only with NBI.

Conclusions NBI/EGGIM score alone is a non-inferior method of identifying GIM compared with the cumbersome Sydney protocol. Thus, NBI could be considered as a sole screening tool for GIM, diminishing risk of biopsy, cost, and work burden.

Citation: Kourkoulis P, Kapizioni C, Koutoufaris G et al. OP154 CAN NBI ALONE ACCURATELY IDENTIFY GIM IN A LOW RISK POPULATION COMPARED WITH SYDNEY PROTOCOL? PRELIMINARY DATA FROM A PILOT STUDY IN A NON-ACADEMIC CENTER. Endoscopy 2021; 53: S62.

Publication History

Article published online:
19 March 2021