A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions

Pedro Pimentel-Nunes; Diogo Libânio; Jorge Lage; Diogo Abrantes; Miguel Coimbra; Gianluca Esposito; David Hormozdi; Mike Pepper; Silvia Drasovean; Jonathan R. White; Daniela Dobru; James Buxbaum; Krish Ragunath; Bruno Annibale; Mário Dinis-Ribeiro

doi:10.1055/s-0042-108435

Endoscopy, Table of Contents

Endoscopy 2016; 48(08): 723-730
DOI: 10.1055/s-0042-108435

Original article

A multicenter prospective study of the real-time use of narrow-band imaging in the diagnosis of premalignant gastric conditions and lesions

Authors

Pedro Pimentel-Nunes

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

²Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
Diogo Libânio

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
Jorge Lage

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
Diogo Abrantes

³Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal
Miguel Coimbra

³Instituto de Telecomunicações, Faculty of Sciences of the University of Porto, Porto, Portugal
Gianluca Esposito

⁴Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy
David Hormozdi

⁵Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Mike Pepper

⁵Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Silvia Drasovean

⁶University of Medicine and Pharmacy TG., Mures, Romania
Jonathan R. White

⁷NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
Daniela Dobru

⁶University of Medicine and Pharmacy TG., Mures, Romania
James Buxbaum

⁵Los Angeles County Hospital, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Krish Ragunath

⁷NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
Bruno Annibale

⁴Department of Medicine, Surgery and Translational Medicine, University Hospital Sant'Andrea, University Sapienza Roma, Rome, Italy
Mário Dinis-Ribeiro

¹Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal

²Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal

Abstract

Background and aim: Some studies suggest that narrow-band imaging (NBI) can be more accurate at diagnosing gastric intestinal metaplasia and dysplasia than white-light endoscopy (WLE) alone. We aimed to assess the real-time diagnostic validity of high resolution endoscopy with and without NBI in the diagnosis of gastric premalignant conditions and to derive a classification for endoscopic grading of gastric intestinal metaplasia (EGGIM).

Methods: A multicenter prospective study (five centers: Portugal, Italy, Romania, UK, USA) was performed involving the systematic use of high resolution gastroscopes with image registry with and without NBI in a centralized informatics platform (available online). All users used the same NBI classification. Histologic result was considered the diagnostic gold standard.

Results: A total of 238 patients and 1123 endoscopic biopsies were included. NBI globally increased diagnostic accuracy by 11 percentage points (NBI 94 % vs. WLE 83 %; P < 0.001) with no difference in the identification of Helicobacter pylori gastritis (73 % vs. 74 %). NBI increased sensitivity for the diagnosis of intestinal metaplasia significantly (87 % vs. 53 %; P < 0.001) and for the diagnosis of dysplasia (92 % vs. 74 %). The added benefit of NBI in terms of diagnostic accuracy was greater in OLGIM III/IV than in OLGIM I/II (25 percentage points vs. 15 percentage points, respectively; P < 0.001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for EGGIM in the identification of extensive metaplasia was 0.98.

Conclusions: In a real-time scenario, NBI demonstrates a high concordance with gastric histology, superior to WLE. Diagnostic accuracy higher than 90 % suggests that routine use of NBI allows targeted instead of random biopsy samples. EGGIM also permits immediate grading of intestinal metaplasia without biopsies and merits further investigation.

Full Text

References

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