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

Nunes, P. Pimentel Nunes ; Libânio, D. Libânio ; Lage, J. Lage ; Abrantes, Diogo Abrantes ; Coimbra, M. ; Esposito, G. Esposito ; Hormozdi, D. Hormozdi ; Pepper, M. Pepper ; Drasovean, S. Drasovean ; White, J. White ; Dobru, D. Dobru ; Buxbaum, J. Buxbaum ; Ragunath, K. Ragunath ; Annibale, B. Annibale ; Ribeiro, M. Dinis-Ribeiro

Endoscopy Vol. 9, Nº ., pp. . - ., June, 2016.

ISSN (print): 0013-726X
ISSN (online): 1438-8812

Journal Impact Factor: 5,196 (in 2015)

Digital Object Identifier: 10.1055/s-0042-108435

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.