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Endoscopic Tri-Modal Imaging Improves Detection of Gastric Intestinal Metaplasia Among a High-Risk Patient Population in Singapore

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An Erratum to this article was published on 23 October 2013

Abstract

Background

Detection of pre-neoplastic gastric mucosal changes and early gastric cancer (EGC) by white-light endoscopy (WLE) is often difficult. In this study we investigated whether combined autofluorescence imaging (AFI) and narrow band imaging (NBI) can improve detection of pre-neoplastic lesions and early gastric cancer in high-risk patients.

Patients and Methods

Chinese patients who were 50-years-old or above with dyspepsia were examined by both high-resolution WLE and combined AFI followed by NBI (AFI–NBI), consecutively in a prospective randomized cross-over setting, by two experienced endoscopists. The primary outcome was diagnostic ability of the two methods for patients with pre-neoplastic lesions such as intestinal metaplasia (IM) and mucosal atrophy.

Results

Sixty-five patients were recruited. One patient with large advanced gastric cancer was found and excluded from the analysis. Among the remaining 64 patients, 38 (59 %) had IM; of these, 26 (68 %) were correctly identified by AFI–NBI (sensitivity 68 %, specificity 23 %) and only 13 (34 %) by WLE (sensitivity 34 %, specificity 65 %). AFI–NBI detected more patients with IM than did WLE (p = 0.011). Thirty-one patients (48 %) had mucosal atrophy. Ten patients (32 %) were identified by AFI–NBI (sensitivity 32 %, specificity 79 %) and four patients (13 %) by WLE (sensitivity 13 %, specificity 88 %) (p = 0.100). No dysplasia or EGC was found.

Conclusion

AFI–NBI identified significantly more patients with IM than did WLE. Our result warrants further studies to define the role of combined AFI–NBI endoscopy for detection of precancerous conditions.

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References

  1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–362.

    PubMed  Google Scholar 

  2. Dan YY, So JBY, Yeoh KG. Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol. 2006;4:709–716.

    Article  PubMed  Google Scholar 

  3. Axon AT, Everette SM. Early gastric cancer in Europe. Gut. 1997;41:142–150.

    Article  PubMed  Google Scholar 

  4. Correa P, Chen VW. Gastric cancer. Cancer Surv. 1994;19–20:55–76.

    PubMed  Google Scholar 

  5. Kobayashi M, Tajiri H, Seike E, et al. Detection of early gastric cancer by a real-time autofluorescence imaging system. Cancer Lett. 2001;165:155–159.

    Article  PubMed  CAS  Google Scholar 

  6. Gono K, Obi T, Yamaguchi M, et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt. 2004;9:568–577.

    Article  PubMed  Google Scholar 

  7. Kara MA, Peters FP, Fockens P, ten Kate FJW, Bergman JJ. Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in barrett’s esophagus. Gastrointest Endosc. 2006;64:176–184.

    Article  PubMed  Google Scholar 

  8. Curvers WL, Singh R, Wong-Kee Song LM et al. Endoscopic tri-modal imaging for detection of early neoplasia in barrett’s oesophagus: a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut 2008; 57:167–172.

  9. Uedo N, Iishi H, Ishihara R, Higashino K, Takeuchi Y. Novel autofluorescence videoendoscopy Imaging system for diagnosis of cancers in the digestive tract. Dig Endosc. 2006; 18:131–136.

    Google Scholar 

  10. Uedo N, Iishi H, Tatsuta M, et al. A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastrc cancers. Gastrointest Endosc. 2005;4:521–528.

    Article  Google Scholar 

  11. Yao K, Takaki Y, Matsui T et al. Clinical application of magnification endoscopy and narrow-band imaging in the upper gastrointestinal tract: New imaging techniques for detecting and characterizing gastrointestinal neoplasia. Gastrointest. Endosc. Clin. N. Am. 2008;18:415–433, vii–viii.

    Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  13. Lauwers GY, Srivastava A. Gastic preneoplastic lesions and epithelial dysplasia. Gastroenteral Clin N Am. 2007;36:813–829.

    Article  Google Scholar 

  14. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20:1161–1181.

    Article  PubMed  CAS  Google Scholar 

  15. Testoni PA, Bonassi U, Bagnolo F, et al. In diffuse atrophic gastritis, routine histology underestimates Helicobacter pylori infection. J Clin Gastroenterol. 2002;35:234–239.

    Article  PubMed  Google Scholar 

  16. Kang HY, Kim N, Park YS, et al. Progression of atrophic gastritis and intestinal metaplasia drives Helicobacter pylori out of the gastric mucosa. Dig Dis Sci. 2006;51:2310–2315.

    Article  PubMed  Google Scholar 

  17. Zhu F, Loh M, Hill J, et al. Genetic factors associated with intestinal metaplasia in a high risk Singapore-Chinese population: a cohort study. BMC Gastroenterol. 2009;9:76.

    Article  PubMed  Google Scholar 

  18. Lin BR, Shun CT, Wang TH, Lin JT. Endoscopic diagnosis of intestinal metaplasia of stomach-accuracy judged by histology. Hepatogastroenterology. 1999;46:162–166.

    PubMed  CAS  Google Scholar 

  19. Mutoh H, Hakamata Y, Sato K, et al. Conversion of gastric mucosa to intestinal metaplasia in Cdx2-expressing transgenic mice. Biochem Biophys Res Commun. 2002;294:470–479.

    Article  PubMed  CAS  Google Scholar 

  20. Mutoh H, Sakurai S, Satoh K, et al. Development of gastric carcinoma from intestinal metaplasia in Cdx2-transgenic mice. Cancer Res. 2004;64:7740–7747.

    Article  PubMed  CAS  Google Scholar 

  21. Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345:784–789.

    Article  PubMed  CAS  Google Scholar 

  22. de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology. 2008;134:945–952.

    Article  PubMed  Google Scholar 

  23. Wong-Kee Song LM, Adler DG, Chand B et al. Chromoendoscopy. Gastrointest Endosc. 2007; 66:639–649.

  24. Yao K, Oishi T, Matsui T, Yao T, Iwashita A. Novel magnified endoscopic findings of microvascular architecture in intra-mucosal gastric cancer. Gastrointest Endosc. 2002;56:279–284.

    Article  PubMed  Google Scholar 

  25. Kato M, Kaise M, Yonezawa J, et al. Trimodal imaging endoscopy may improve diagnostic accuracy of early gastric neoplasia: a feasibility study. Gastrointest Endosc. 2009;70:899–906.

    Article  PubMed  Google Scholar 

  26. Sauerbruch T, Schreiber MA, Schussler P, Permanetter W. Endoscopy in the diagnosis of gastritis. Diagnostic value of endoscopic criteria in relation to histological diagnosis. Endoscopy. 1984;16:101–104.

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  28. Lim JH, Kim N, Lee HS, et al. Correlation between endoscopic and histological diagnoses of gastric intestinal metaplasia. Gut Liver. 2013;7:41–50.

    Article  PubMed  Google Scholar 

  29. Fukuta N, Ida K, Kato T, et al. Endoscopic diagnosis of gastric intestinal metaplasia: a prospective multicenter study. Dig Endosc. (Epub ahead of print). doi:10.1111/den.12032.

  30. Bansal A, Ulusarac O, Mathur S, Sharma P. Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial. Gastrointest Endosc. 2008;67:210–216.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  32. Gwee KA, Teng L, Wong RK, Ho KY, Sutejia DS, Yeoh KG. The response of Asian patients with functional dyspepsia to eradication of helicobacter pylori infection. Eur J Gastroenterol Hepatol. 2009;21:417–424.

    Article  PubMed  Google Scholar 

  33. Silva FB, Dinis-Ribeiro M, Vieth M, et al. Endocopic assessment and grading pf Barrett’s esophagus using magnifying endoscopy and narrow-band imaging: accuracy and interobserver agreement of different classification systems. Gastrointest Endosc. 2011;73:22.

    Article  Google Scholar 

Download references

Conflict of interest

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Authors and Affiliations

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

    Jimmy So & Amy Tay

  2. Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore

    Andrea Rajnakova

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

    Yiong-Huak Chan

  4. Oncology Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Nilesh Shah

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

    Manuel Salto-Tellez & Ming Teh

  6. Department of Gastrointestinal Oncology, Osaka Medical Centre for Cancer and Cardiovascular Disease, Osaka, Japan

    Uedo Noriya

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  1. Jimmy So
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  4. Amy Tay
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Corresponding author

Correspondence to Jimmy So.

Additional information

Registration number: NCT01132534.

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So, J., Rajnakova, A., Chan, YH. et al. Endoscopic Tri-Modal Imaging Improves Detection of Gastric Intestinal Metaplasia Among a High-Risk Patient Population in Singapore. Dig Dis Sci 58, 3566–3575 (2013). https://doi.org/10.1007/s10620-013-2843-2

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  • DOI: https://doi.org/10.1007/s10620-013-2843-2

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