Abstract
Aims The aims of this study were to characterize nonatrophic and atrophic gastric mucosa under conventional endoscopy and probe-based confocal laser endomicroscopy (pCLE) modes and to define quantitative diagnostic parameters for these lesions under pCLE. Method In phase I, 64 patients with gastric mucosal lesions diagnosed by gastrointestinal endoscopy were enrolled in the study. Normal mucosa and suspicious lesions were evaluated under normal white light imaging (WLI) and pCLE mode. Descriptive characteristic of gastric mucosal inflammation and atrophy under pCLE were defined according to the histology. In phase II, the criteria for nonatrophic gastritis (NAG) and chronic atrophic gastritis (CAG) under pCLE were used to diagnose the mucosal lesions in 431 patients. Diagnostic accuracy of each endoscopy modes was evaluated by measuring the concordance with histology. Result A total of 64 patients with 187 positions were enrolled in the first part of this study. According to the histological diagnosis, the vessel diameter was increased in the NAG (11.18 ± 0.1 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 μm) and CAG (13.21 ± 0.29 Conclusion pCLE shows high potential for the diagnosis of gastric inflammation and atrophy based on quantitative criteria and has the ability to be a substitute for histology in the diagnosis of diffuse lesions in the stomach.
Highlights
Atrophic gastritis (AG) is defined as the loss of appropriate glands with/without replacement by intestinal-type epithelium and fibrous tissue. e relationship between atrophic gastritis and gastric cancer has been established in numerous studies [1,2,3]
Using quantitative criteria for probe-based confocal laser endomicroscopy (pCLE) such as the distance between glands allowed evaluating the type of chronic gastritis in vivo and in real time
Conventional endoscopy is not frequently correlated with histological alterations for predicting histological gastritis [17]. e concordance of CAG diagnosed by white light imaging (WLI) was poor compared to histology in the present study
Summary
Atrophic gastritis (AG) is defined as the loss of appropriate glands with/without replacement by intestinal-type epithelium and fibrous tissue. e relationship between atrophic gastritis and gastric cancer has been established in numerous studies [1,2,3]. It is important to screen for gastric mucosa atrophy during endoscopy. Conventional white light imaging (WLI) endoscopy cannot accurately differentiate and diagnose mucosal atrophy and intestinal metaplasia. Histology is the gold standard in diagnosing gastric lesions during traditional endoscopy. According to the updated Sydney system, at least five nontargeted biopsies (from the incisura and the lesser and greater curvature of both the gastric antrum and the corpus) and target biopsies of lesions should be taken for adequate assessment of gastric conditions [4]. Biopsy can still not assess the mucosa condition in site and in real time, and the mucosal injury caused by forceps is, in addition, difficult to avoid. Techniques are needed to better differentiate normal from abnormal mucosa and facilitate the use of targeted, rather than random, biopsy protocols
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