Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 16132 Genova, Italy.
World J Gastroenterol. 2013 May 7;19(17):2668-75. doi: 10.3748/wjg.v19.i17.2668.
To investigate the predictive value of narrow-band imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients.
We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings.
We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI: 67-92), a specificity of 96% (95%CI: 93-99), a positive predictive value of 84% (95%CI: 73-96), a negative predictive value of 95% (95%CI: 92-98), and an accuracy of 93% (95%CI: 90-97). The NBI-ME examination overlooked GIM in 8 cases, but the GIM was less than 5% in 7 of the cases. Moreover, in the 6 false positive cases, the histological examination showed the presence of reactive gastropathy (4 cases) or H. pylori active chronic gastritis (2 cases). The semiquantitative correlation between the rate of LBC appearance and the percentage of GIM was 79% (P < 0.01).
NBI-ME achieved good sensitivity and specificity in recognising GIM in an unselected population. In routine clinical practice, this technique can reliably target gastric biopsies.
研究窄带成像放大内镜（NBI-ME）在未选择患者中识别胃肠化生（GIM）的预测价值。
我们前瞻性评估了因上腹部不适/疼痛、贫血、胃食管反流病、疑似消化性溃疡病或慢性肝病等各种原因接受上消化道内镜检查的连续患者。患者接受了由三位经验丰富的盲法内镜医生进行的 NBI-ME 检查。此外，为了确定是否存在 GIM，我们还进行了五项活检（2 项胃窦、1 项胃角和 2 项胃体），由两位病理学家进行检查，他们不知道内镜检查结果。测量了浅蓝色嵴（LBC）外观与组织学之间的相关性。此外，我们将 LBC 外观的程度量化为图像场的小于 20%（+）、20%-80%（++）和大于 80%（+++），并将 LBC 外观的半定量评估与组织学中 GIM 百分比进行了相关性分析。
我们纳入了 100 名（58 名女性/42 名男性）患者，他们主要因胃食管反流病/消化不良（46%）、癌症筛查/贫血（34%）、慢性肝病（9%）和疑似乳糜泻（6%）就诊；其余患者因其他原因就诊。从活检中检测到的幽门螺杆菌（H. pylori）感染率为 31%，而 67%的患者使用质子泵抑制剂。在 33 名患者的胃窦部发现了 LBC（33%）；其中 20 例为 LBC+，9 例为 LBC++，4 例为 LBC+++。在 6 名患者的胃体部发现了 LBC（6%），其中 5 例在胃窦部也有 LBC。LBC 外观与组织学 GIM 之间的相关性良好，敏感性为 80%（95%CI：67-92），特异性为 96%（95%CI：93-99），阳性预测值为 84%（95%CI：73-96），阴性预测值为 95%（95%CI：92-98），准确率为 93%（95%CI：90-97）。NBI-ME 检查漏诊了 8 例 GIM，但其中 7 例 GIM 小于 5%。此外，在 6 例假阳性病例中，组织学检查显示存在反应性胃炎（4 例）或 H. pylori 活动性慢性胃炎（2 例）。LBC 外观率与 GIM 百分比之间的半定量相关性为 79%（P<0.01）。
NBI-ME 在未选择人群中识别 GIM 具有良好的敏感性和特异性。在常规临床实践中，该技术可以可靠地针对胃活检。
