Narrow band imaging and serology in the assessment of premalignant gastric pathology

Jonathan R White,Sarmed S Sami,Dona Reddiar,Jayan Mannath,Jacobo Ortiz-Fernández-Sordo,Sabina Beg,Robert Scott,Prarthana Thiagarajan,Saqib Ahmad,Adolfo Parra-Blanco,Madhavi Kasi,Emmanouil Telakis,Alyshah A Sultan,Jillian Davis,Adam Figgins,Philip Kaye,Karen Robinson,John C Atherton,Krish Ragunath

doi:10.1080/00365521.2018.1542455

Abstract

Background: Patient outcomes in gastric adenocarcinoma are poor due to late diagnosis. Detecting and treating at the premalignant stage has the potential to improve this. Helicobacter pylori is also a strong risk factor for this disease.Aims: Primary aims were to assess the diagnostic accuracy of magnified narrow band imaging (NBI-Z) endoscopy and serology in detecting normal mucosa, H. pylori gastritis and gastric atrophy. Secondary aims were to compare the diagnostic accuracies of two classification systems using both NBI-Z and white light endoscopy with magnification (WLE-Z) and evaluate the inter-observer agreement.Methods: Patients were prospectively recruited. Images of gastric mucosa were stored with histology and serum for IgG H. pylori and Pepsinogen (PG) I/II ELISAs. Blinded expert endoscopists agreed on mucosal pattern. Mucosal images and serological markers were compared with histology. Kappa statistics determined inter-observer variability for randomly allocated images among four experts and four non-experts.Results: 116 patients were prospectively recruited. Diagnostic accuracy of NBI-Z for determining normal gastric mucosa was 0.87(95%CI 0.82–0.92), H. pylori gastritis 0.65(95%CI 0.55–0.75) and gastric atrophy 0.88(95%CI 0.81–0.94). NBI-Z was superior to serology at detecting gastric atrophy: NBI-Z gastric atrophy 0.88(95%CI 0.81-0.94) vs PGI/II ratio < 3 0.74(95%CI 0.62–0.85) p<.0001. Overall NBI-Z was superior to WLE-Z in detecting disease using two validated classifications. Inter-observer agreement was 0.63(95%CI 0.51–0.73).Conclusions: NBI-Z accurately detects changes in the GI mucosa which currently depend on histology. NBI-Z is useful in the detection of precancerous conditions, potentially improving patient outcomes with early intervention to prevent gastric cancer.

Highlights

Introduction eeHelicobacter pylori (H. pylori) colonizes the gastric mucosa of approximately 50% of the world’s population, the prevalence varies between countries the infection rates are higher in developing countries [1, 2]
Narrow band imaging (NBI)-Z accurately detects changes in the GI mucosa which currently depend on histology
NBI-Z diagnostic accuracy for determining normal corpus (Type I) was 0.87, H. pylori gastritis (Type II/III) 0.65 and gastric atrophy (Type IV)

Summary

Introduction

Helicobacter pylori (H. pylori) colonizes the gastric mucosa of approximately 50% of the world’s population, the prevalence varies between countries the infection rates are higher in developing countries [1, 2]. H. pylori infects individuals during childhood and typically ev persists lifelong in the absence of effective eradication therapy [3]. In 15% of individuals infection leads to serious complications such as peptic ulcer disease, distal gastric iew adenocarcinoma or primary gastric mucosa associated lymphoid tissue (MALT) lymphoma [4]. Other conditions associated with H. pylori include iron deficiency anemia, gastric atrophy and idiopathic thrombocytopenia purpura [5, 6]. H. pylori infection has been suggested to be a. Patient outcomes in gastric adenocarcinoma are poor due to late diagnosis. H. pylori is a strong risk factor for this disease

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Results

Conclusion