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, ...)
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
