ENHANCED ENDOSCOPY FOR THE DIAGNOSIS OF GASTRICANTRALINTESTINAL METAPLASIA

Abstract

Background: The detection of early gastric cancer may improve survival and avoid major gastric surgeries. Gastric Intestinal Metaplasia (GIM) is a precancerous lesion of the stomach. Screening for GIM may therefore lead to early detection of gastric neoplastic lesions. Objective: This study was designed to determine the effect of conventional Narrow Band Image (NBI) in combination with acetic acid (AA-NBI) on the diagnosis of antral GIM. Patients and Methods: The present study was performed in 100 consecutive adults who required endoscopic examination at AL Hussein University Hospital, Department of Internal Medicine, Endoscopy Unit, Conventional white-light endoscopy (WLE), NBI and AA-NBI was performed in all patients by the same endoscopist during a single procedure with a GIF Q290 endoscope (Olympus Medical Systems, Tokyo, Japan), All suspicious antral gastric lesions was photographed. Any abnormal mucosal change, such as localized discoloration and rough areas, was considered indicative of GIM lesions. Results: Fifty-six (56.0%) out of the 100 individuals examined were found to have GIM (by biopsy), of which 34 (60.7%) were diagnosed correctly by NBI (sensitivity 66.7% and specificity 68.2%) and 42 (75%) were correctly identified by AA–NBI (sensitivity 75% and specificity 73.91%), as compared to only 24 (42.86%) by WLE (sensitivity 42.86% and specificity 37.5%). 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. Conclusion: Acetic acid staining combined with NBI was of a higher sensitivity and specificity in the diagnosis of intestinal metaplasia in gastric mucosa, which was in good consistency with the pathological diagnosis. Compared with the normal NBI, it was more capable to detect lesions of intestinal metaplasia in gastric mucosa, improved the accuracy of targeted biopsy to intestinal metaplasia, and has an important significance in the early detection and treatment of tumors.