High Resolution White Endoscopy with Chromoendoscopy and Confocal Laser Endomicroscopy for Atrophic Gastritis Surveillance: One Center Experience

Abstract

Purpose: Atrophic gastritis (AG) is a well-characterized premalignant condition with a significantly increased risk for developing gastric neoplasia. A rigorous upper endoscopy surveillance program has been shown to undoubtedly reduce this risk. However, white light endoscopy random multiple biopsies in the regular standard of care missed lesions of high grade dysplasia and neoplasia in atrophic gastritis with commonly in patchy distribution. Recently, multiple new endoscopic imaging technologies such as chromoendoscopy with indigo carmine, which, with increased sensitivity, are able to obtain, and confocal laser endomicroscopy (CLE), which is developed to provide a more detailed visualization of the mucosa by enhancing morphology and vascularization with high specificity. Methods: In this prospective clinical trial, 20 patients from the First Hospital of Jilin University undergoing endoscopic screening and surveillance for AG were enrolled. High-definition white light endoscopy followed by indigo carmine sprayed in the antrum was performed to search for highly interested spot of lesions in antrum, followed by the CLE scan performed by two endoscopists experienced more than 30 CLE examinations and biopsy for standard histological pathologic diagnosis as “ gold standard”, and sent to a single GI pathologist to provide diagnosis. The endoscopists CLE diagnosis and standard pathologic diagnosis were compared. Results: The comparison of CLE plus chromoendoscopy to histological pathology diagnosis is sensitivity 89.00%, and specificity 87.50% in atrophic gastritis (Kappa=0.0495, 0.4<k<0.75), sensitivity 97.98%, specificity 94.59% (Kappa=0.557, 0.4<k<0.75). Conclusion: CLE has significant consistency to the pathology diagnosis in the atrophic gastritis and intestinal metaplasia. CLE with chromoendoscopy enhances the diagnostic accuracy, clinical real-time result and decision. CLE with chromoendoscopy has potential advantage for diagnosis and treatment of atrophic gastritis.