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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25003748
DOI: 10.1055/a-2500-3748
Original article

Endoscopic grading of gastric intestinal metaplasia using blue light imaging in a low-risk population: Multicenter cross-sectional validation study

Marta Rodriguez-Carrasco 
1   Gastroenterology Department, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal (Ringgold ID: RIN59035)
,
Gianluca Esposito
2   Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
,
Emanuele Dilaghi
2   Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
,
Guido Manfredi
3   Gastroenterology and Endoscopy Department, Maggiore Hospital Crema, Crema, Italy
,
Saverio Alicante
3   Gastroenterology and Endoscopy Department, Maggiore Hospital Crema, Crema, Italy
,
Elisabetta Buscarini
3   Gastroenterology and Endoscopy Department, Maggiore Hospital Crema, Crema, Italy
,
Bruno Annibale
2   Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
,
Mário Dinis-Ribeiro
1   Gastroenterology Department, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal (Ringgold ID: RIN59035)
4   Porto Comprehensive Cancer Center & RISE@CI-IPO, University of Porto, Porto, Portugal (Ringgold ID: RIN18550)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT04768218, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Multi-center, cross-sectional study
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Abstract

Background study aims

Detecting gastric intestinal metaplasia (GIM) with white light endoscopy (WLE) remains a challenge and virtual chromoendoscopy methods have been shown to increase accuracy. We aimed to externally validate the Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) using blue light imaging (BLI).

Methods

First, the reliability of BLI and the EGGIM score was evaluated through assessment of 90 images divided into three sets of 30. A multicenter cross-sectional study was conducted at two Italian centers involving 102 patients (510 biopsies). Both per-biopsy and per-patient analyses were performed to ascertain accuracy of BLI in detecting and staging GIM (vs. histology).

Results

BLI significantly enhanced interobserver agreement of endoscopic diagnosis of GIM, with a Fleiss Kappa of 0.4 (95% confidence interval [CI] 0.3–0.5), compared to 0.2 (95% CI 0.2–0.3) with WLE. Concordance was particularly strong in applying the EGGIM score (weighted Kappa 0.7; 95% CI 0.5–0.9). BLI showed significant improvements in sensitivity over WLE, with an increase observed in both per-biopsy analysis (82%; 95%CI 73.7–89.0 vs. 50%;95% CI 40.6–60.3) and per-patient analysis (96%; 95% CI 84.5–99.4 vs. 68%;95% CI 52.4-81.4). The area under the curve of EGGIM in diagnosing OLGIM III/IV was 0.9 (95% CI 0.8–1.0), confirming EGGIM > 4 being the optimal threshold (sensitivity of 80%, specificity of 88%).

Conclusions

Our study validates BLI integrated with the EGGIM system as an effective strategy, highlighting its precision in identifying advanced GIM stages. BLI's notable sensitivity enhances its use as a complementary tool to WLE, significantly improving gastric cancer risk assessment.

Keywords

Endoscopy Upper GI Tract - Precancerous conditions & cancerous lesions (displasia and cancer) stomach - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Endoscopic resection (ESD, EMRc, ...)


Publication History

Received: 18 June 2024

Accepted after revision: 03 December 2024

Article published online:
29 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Marta Rodriguez-Carrasco, Gianluca Esposito, Emanuele Dilaghi, Guido Manfredi, Saverio Alicante, Elisabetta Buscarini, Bruno Annibale, Mário Dinis-Ribeiro. Endoscopic grading of gastric intestinal metaplasia using blue light imaging in a low-risk population: Multicenter cross-sectional validation study. Endosc Int Open 2025; 13: a25003748.
DOI: 10.1055/a-2500-3748
 

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