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Comparison of probe-based confocal endomicroscopy with virtual chromoendoscopy and white-light endoscopy for diagnosis of gastric intestinal metaplasia

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Abstract

Objective

We prospectively compared the diagnostic performance of autofluorescence imaging (AFI), magnifying narrow band imaging (mNBI), and probe-based confocal laser endomicroscopy (pCLE) with white light endoscopy (WLE) for the diagnosis of gastric intestinal metaplasia (GIM), using histology as the “gold standard.”

Design

Chinese >50 years old with history of GIM were prospectively recruited. All subjects underwent WLE, followed by AFI and NBI, and finally pCLE. Patients were randomized to undergo either AFI before NBI or vice versa. In each patient, a minimum of six sites (antrum lesser and greater curve, body lesser and greater curve, incisura, cardia, and any lesion) were each examined by WLE, AFI, NBI, and pCLE. The diagnoses were made real-time. Biopsies for histology were taken from all examined sites. pCLE videos also were reviewed off-site. Analysis was performed per-site.

Results

A total of 125 sites in 20 patients were examined. For diagnosing GIM, real-time pCLE had better sensitivity (90.9 vs. 37.9 %, p < 0.001) and accuracy (88.0 vs. 64.8 %, p < 0.001) compared with WLE. Sensitivity (90.9 vs. 68.2 %, p = 0.001), specificity (84.7 vs. 69.5 %, p = 0.042), and accuracy (88 vs. 68.8 %, p < 0.001) of real-time pCLE were better than AFI. Sensitivity, specificity, and accuracy of real-time pCLE and mNBI for diagnosing GIM were similar. Off-site pCLE had significantly better accuracy for diagnosing GIM compared to WLE, AFI, and mNBI. Off-site pCLE had superior specificity (94.9 vs. 84.7 %, p = 0.031) and accuracy (95.2 vs. 88.0 %, p = 0.012) compared with real-time pCLE.

Conclusions

pCLE was superior to AFI and WLE for diagnosing GIM. Off-site review improved performance of pCLE.

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Abbreviations

pCLE:

Probed based confocal laser endomicroscopy

WLE:

White-light endoscopy

mNBI:

Magnifying narrow-band imaging

AFI:

Autofluorescence imaging

GIM:

Gastric intestinal metaplasia

References

  1. Dan YY, So JB, Yeoh KG (2006) Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol 4(6):709–716

    Article  PubMed  Google Scholar 

  2. Correa P (1992) Human gastric carcinogenesis: a multistep and multifactorial process. First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res 52:6735–6740

    PubMed  CAS  Google Scholar 

  3. Kaminishi M, Yamaguchi H, Nomura S et al (2002) Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis. Dig Endosc 14:138–151

    Article  Google Scholar 

  4. Inoue T, Uedo N, Ishihara R et al (2010) Autofluorescence imaging videoendoscopy in the diagnosis of chronic atrophic fundal gastritis. J Gastroenterol 45(1):45–51

    Article  PubMed  Google Scholar 

  5. Uedo N, Ishihara R, Iishi H et al (2006) A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy 38(8):819–824

    Article  PubMed  CAS  Google Scholar 

  6. Lim LG, Yeoh KG, Salto-Tellez M et al (2011) Experienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images. Gastrointest Endosc 73(6):1141–1147

    Article  PubMed  Google Scholar 

  7. Guo YT, Li YQ, Yu T et al (2008) Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study. Endoscopy 40(7):547–553

    Article  PubMed  Google Scholar 

  8. Buchner AM, Shahid MW, Heckman MG et al (2010) Comparison of probe-based confocal laser endomicroscopy with virtual chromoendoscopy for classification of colon polyps. Gastroenterology 138(3):834–842

    Article  PubMed  Google Scholar 

  9. Kiesslich R, Gossner L, Goetz M et al (2006) In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol 4:979–987

    Article  PubMed  Google Scholar 

  10. Pohl H, Rosch T, Vieth M et al (2008) Miniprobe confocal laser microscopy for the detection of invisible neoplasia in patients with Barrett’s oesophagus. Gut 57:1648–1653

    Article  PubMed  CAS  Google Scholar 

  11. Wallace MB, Sharma P, Lightdale C et al (2010) Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett’s esophagus with probe-based confocal laser endomicroscopy. Gastrointest Endosc 72:19–24

    Article  PubMed  Google Scholar 

  12. Bajbouj M, Vieth M, Rosch T et al (2010) Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy 42:435–440

    Article  PubMed  CAS  Google Scholar 

  13. Lim LG, Bajbouj M, von Delius S et al (2011) Fluorescein-enhanced autofluorescence imaging for accurate differentiation of neoplastic from non-neoplastic colorectal polyps: a feasibility study. Endoscopy 43(5):419–424

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Zhu Feng, Ms. Yeo Lei Pheng, Ms. Teo Ai Lian, Ms. See Huiqi Vinnie, and Ms. Lynette Phay for their assistance.

Disclosures

Lee Guan Lim, Khay Guan Yeoh, Supriya Srivastava, Yiong Huak Chan, Ming Teh, and Khek Yu Ho have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, National University Health System, 10 Kent Ridge Crescent, Singapore, 119260, Singapore

    Lee Guan Lim, Khay Guan Yeoh & Khek Yu Ho

  2. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Lee Guan Lim, Khay Guan Yeoh & Khek Yu Ho

  3. Cancer Science Institute, National University Singapore, Singapore, Singapore

    Supriya Srivastava

  4. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Yiong Huak Chan

  5. Department of Pathology, National University Health System, Singapore, Singapore

    Ming Teh

Authors
  1. Lee Guan Lim
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  2. Khay Guan Yeoh
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  3. Supriya Srivastava
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  4. Yiong Huak Chan
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  5. Ming Teh
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  6. Khek Yu Ho
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Corresponding author

Correspondence to Khek Yu Ho.

Additional information

ClinicalTrials.gov Identifier: NCT01398579.

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Lim, L.G., Yeoh, K.G., Srivastava, S. et al. Comparison of probe-based confocal endomicroscopy with virtual chromoendoscopy and white-light endoscopy for diagnosis of gastric intestinal metaplasia. Surg Endosc 27, 4649–4655 (2013). https://doi.org/10.1007/s00464-013-3098-x

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  • DOI: https://doi.org/10.1007/s00464-013-3098-x

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