Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Gastroenterology, Asahi University Hospital, Gifu, Japan.
Gastrointest Endosc. 2019 Jan;89(1):47-57. doi: 10.1016/j.gie.2018.08.049. Epub 2018 Sep 4.
Blue laser imaging-bright (BLI-bright) has shown promise as a more useful tool for detection of early gastric cancer (EGC) than white-light imaging (WLI). However, the diagnostic performance of BLI-bright in the detection of EGC has not been investigated. We aimed to compare real-time detection rates of WLI with that of BLI-bright for EGC.
This was a prospective, randomized, controlled study in 2 Japanese academic centers. We investigated 629 patients undergoing follow-up endoscopy for atrophic gastritis with intestinal metaplasia or surveillance after endoscopic resection of EGC. Patients were randomly assigned to receive primary WLI followed by BLI-bright or primary BLI-bright followed by WLI. The real-time detection rates of EGC were compared between primary WLI and primary BLI-bright.
There were 298 patients in each group. The real-time detection rate of EGC with primary BLI-bright was significantly greater than that with primary WLI (93.1% vs 50.0%; P = .001). Primary BLI-bright had a significantly greater ability to detect EGCs in patients with a history of endoscopic resection for EGC, no Helicobacter pylori infection in the stomach after eradication therapy, lesions with an open-type atrophic border, lesions in the lower third of the stomach, depressed-type lesions, small lesions measuring <10 mm and 10 to 20 mm in diameter, reddish lesions, well-differentiated adenocarcinomas, and lesions with a depth of invasion of T1a.
BLI-bright has a higher real-time detection rate for EGC than WLI. BLI-bright should be performed during surveillance endoscopy in patients at high risk for EGC. (Clinical trial registration number: UMIN000011324.).
蓝激光成像-明亮（BLI-bright）在检测早期胃癌（EGC）方面比白光成像（WLI）更有希望成为一种更有用的工具。然而，BLI-bright 在检测 EGC 方面的诊断性能尚未得到研究。我们旨在比较 WLI 和 BLI-bright 实时检测 EGC 的检出率。
这是在日本的两个学术中心进行的一项前瞻性、随机、对照研究。我们调查了 629 例因萎缩性胃炎伴肠化生或内镜下切除 EGC 后接受随访内镜检查的患者。患者被随机分配接受原发性 WLI 后进行 BLI-bright 或原发性 BLI-bright 后进行 WLI。比较原发性 WLI 和原发性 BLI-bright 检测 EGC 的实时检出率。
每组各有 298 例患者。原发性 BLI-bright 检测 EGC 的实时检出率明显高于原发性 WLI（93.1%比 50.0%；P =.001）。原发性 BLI-bright 对有 EGC 内镜切除史、根治治疗后胃内无幽门螺杆菌感染、萎缩边界开放型病变、胃下部病变、凹陷型病变、小病变（直径<10mm 和 10 至 20mm）、红色病变、分化良好的腺癌和 T1a 浸润深度病变的患者，检测 EGC 的能力明显更强。
BLI-bright 实时检测 EGC 的检出率高于 WLI。BLI-bright 应在 EGC 高危患者的监测内镜检查中进行。（临床试验注册号：UMIN000011324。）
