Research Article: Acetic Acid Enhanced Narrow Band Imaging for the Diagnosis of Gastric Intestinal Metaplasia

Date Published: January 30, 2017

Publisher: Public Library of Science

Author(s): Jie Sha, Pin Wang, Bingliang Zhu, Minghui Zhu, Xueliang Li, Feng Gao, John Green.


Gastric intestinal metaplasia (GIM) is a precancerous lesion of the stomach. The detection of GIM using conventional white-light endoscopy (WLE) is difficult. In this study, we determined whether acetic acid-enhanced narrow band imaging (AA-NBI) improves the detection of GIM. A consecutive cohort of 132 individuals aged 40 years or older was subjected to upper gastrointestinal endoscopy using WLE, NBI and AA-NBI. The ability of the three methods to diagnose GIM in patients was compared. Histological assessment (per-patient and per-biopsy) was used for the accuracy assessment. Sixty-six (50.0%) out of the 132 individuals examined were found to have GIM, of which 44 (66.7%) were diagnosed correctly by NBI (sensitivity 66.7% and specificity 68.2%) and 58 (87.9%) were correctly identified by AA–NBI (sensitivity 87.9% and specificity 68.2%), as compared to only 22 (33.3%) by WLE (sensitivity 33.3% and specificity 28.8%). Therefore, the sensitivity of AA–NBI in the diagnosis of GIM was significantly higher than NBI (p<0.05) and WLE (p < 0.001). Our study indicates that AA-NBI can improve the accuracy of endoscopy-targeted biopsies for GIM.

Partial Text

Gastric cancer is the third leading cause of cancer death worldwide [1]. The detection of early-stage gastric neoplastic lesions may improve survival and avoid complete resection. Gastric cancer onset is considered a multistep process that includes the consecutive development of chronic gastritis followed by mucosal atrophy, gastric intestinal metaplasia (GIM), dysplasia, and finally adenocarcinoma [2]. The surveillance of patients with GIM may therefore lead to the earlier detection of advanced precancerous lesions and gastric cancer [3].

GIM is an important risk factor for intestinal gastric cancer [2]. However, the diagnosis of GIM using conventional WLE is unreliable because GIM usually appears in flat mucosa with few macroscopic morphological changes and occurs multifocally [4, 20, 21].

The whitish patches observed in the gastric mucosa with AA-NBI are highly accurate indicators for GIM. AA-NBI can improve the accuracy of endoscopy-targeted biopsies for GIM.




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