A single vial is enough in the absence of endoscopic suspected intestinal metaplasia – less is more!

Background: For the correct staging of chronic atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) at least 4 biopsies are recommended: 2 from the antrum/incisura and 2 from the body sent in two different vials. As virtual chromoendoscopy with narrow-band-imaging (NBI) is valid both in the diagnosis and staging of GIM, it is reasonable to question the need to separate biopsy samples in all procedures.

Aims: To evaluate if biopsy samples can be placed in the same vial without implications in the diagnosis and follow-up of the patient, if during gastroscopy no typical endoscopic pattern of GIM with NBI is observed.

Methods: Multicentre prospective study of a consecutive sample of patients (n?=?183) submitted to gastroscopy using NBI with no superficial neoplastic lesions and no suggestive areas of GIM. Biopsies of both antrum/incisure and body were performed in all patients and samples were placed in the same vial for histologic assessment [according to OLGA (operative link for gastritis assessment) and OLGIM (operative link for gastric intestinal metaplasia)], blinded to endoscopic features.

Results: In all patients, OLGA and OLGIM calculation was possible as the pathologists could distinguish biopsy samples from antrum/incisure from those of gastric body. The negative predictive value was 100% for advanced stages of GIM or AG as 179 (98%) patients presented OLGIM 0 and only 4 (2%) presented OLGIM I. Regarding AG, 150 (82%) presented OLGA 0, 23 (13%) OLGA I and 10 (6%) OLGA II.

Conclusion: In the absence of a typical endoscopic pattern of GIM using NBI, it is effective to place biopsies’ specimens in the same vial (for Helicobacter pylori diagnosis) or even to abstain from biopsies as no single patient with significant changes seems to be missed. This change in clinical practice can have a significant impact on endoscopy costs.     

胃黏膜肠上皮化生内镜诊断和分级的研究进展

胃黏膜肠上皮化生（gastric intestinal metaplasia,GIM）是一种癌前组织病理学改变,其临床意义在于对胃癌发生风险的提示,有着大面积肠上皮化生背景的胃黏膜具有较高的癌变风险;另外,不完全型GIM与肠型胃癌相关。因此,GIM的内镜下监测对及时发现和管理早期胃癌具有重要意义。可操作的GIM胃癌风险评估分级提供了较好地针对肠上皮化生的胃黏膜癌变风险评估,但每次评估需要标准的活检,增加了损伤风险,GIM内镜分级在此背景下被提出,但其应用受内镜诊断GIM的准确性和临床使用的便捷性所制约。笔者分析了各类内镜下诊断技术对GIM的诊断效果,结合人工智能辅助识别GIM面积,综述EGGIM评分的可行性。     

Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma: do we still need biopsies?

Objective Early diagnosis of gastric cancer may be achieved through surveillance of patients with extensive gastric intestinal metaplasia (eGIM). However, diagnosis of eGIM generally implies histology. We aimed at determining the accuracy of high-resolution endoscopy with light-narrow band imaging (NBI) to assess the presence of eGIM on a per-patient basis. Material and methods Prospective cohort of 60 patients divided into two groups: derivation cohort (n?=?25) to evaluate the reliability and validity, and a real-time validation group (n?=?35). In the derivation group, six endoscopists with two levels of expertise were asked to estimate the grade of GIM based in endoscopic images (white light endoscopy, light-NBI and amplification/near focus). In the real-time validation set, experienced endoscopists were asked to similarly record their real-time optical diagnosis. Histology was then considered as the gold standard. Results In the derivation group diagnosis accuracy was 60% with WLE (non-expert 59% vs. 61% experts), increasing to 73% after NBI magnification (non-expert 63% vs. 83% expert, p?Conclusion For the first time the reliability of high-resolution endoscopy with light-NBI for extension of GIM is described. Our results suggest that more than 90% of individuals at risk could be identified without the need for biopsies, simplifying the current recommendations.     

Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia

AIM: To evaluate the efficacy of non-sequential narrow band imaging (NBI) for a better recognition of gastric intestinal metaplasia (GIM). METHODS: Previously diagnosed GIM patients underwent targeted biopsy from areas with and without GIM, as indicated by NBI, twice at an interval of 1 year. The authors compared the endoscopic criteria such as light blue crest (LBC), villous pattern (VP), and large long crest (LLC) with standard histology. The results from two surveillance endoscopies were compared with hi...     

Use of endoscopic assessment of gastric atrophy for gastric cancer risk stratification to reduce the need for gastric mapping

Abstract

Background/Aims: Stratification for gastric cancer risk typically involves histologic grading of gastric biopsies. This study aimed to compare endoscopic assessment of gastric atrophy and histologic gastric mapping for gastric cancer risk stratification in a region with relatively high risk of gastric cancer.

Methods: Endoscopic and histologic gastric cancer risk stratification were compared in Vietnamese patients with functional dyspepsia. Endoscopic gastric atrophy was graded according to the Kimura-Takemoto classification. High-risk histologic lesions were defined as gastric dysplasia, Operative Link on Gastritis Assessment (OLGA) gastritis stage III/IV, intestinal metaplasia in both the antrum and the corpus or incomplete intestinal subtype at any site. Two experienced pathologists, blinded to endoscopic information, jointly examined all specimens and reached a consensus. The presence of high-risk histologic lesions was compared among patients with different endoscopic grades of gastric atrophy.

Results: There were 280 subjects (mean age, 46.1?±?10?years, and male, 50%). The numbers of patients with moderate/severe grade of endoscopic gastric atrophy and high-risk histologic lesions were 126 (45.0%) and 46 (16.4%), respectively. The sensitivity, specificity, positive and negative likelihood ratios of moderate/severe endoscopic atrophic grade for detecting high-risk histologic lesions were 93% (95% CI 86%?100%), 65% (95% CI 58%?71%), 2.64 (95% CI 2.18???3.18) and 0.10 (95% CI 0.03???0.30), respectively.

Conclusions: Gastric cancer risk assessment using endoscopic or histologic methods provided similar results such that the absence or a mild grade of endoscopic gastric atrophy would preclude the need for histologic mapping.     

Endoscopic diagnosis of dysplasia in Barrett’s esophagus

Evaluation of: Sharma P, Hawes RH, Bansal A et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut 62(1), 15–21 (2013).

Barrett’s esophagus, or columnar metaplasia with gastric cardiac cells or intestinal cells, develops in the squamous epithelium of the esophageal mucosa in relation to gastroesophageal reflux. An increased risk of neoplasia justifies surveillance at regular intervals. Conventional guidelines recommend detection of areas with intestinal metaplasia or dysplasia by taking random four-quadrant biopsies at every 1 or 2 cm. Alternatively, image processing with narrow band imaging (NBI), is proposed to improve detection. This international and randomized study in persons with Barrett’s esophagus compares conventional endoscopy in white light with random four-quadrant biopsies and NBI imaging with focused biopsies only. Randomization enrolled 123 patients with Barrett’s esophagus who successively underwent exploration with the two methods. The study confirmed that NBI had the same efficacy as white light in the detection of intestinal metaplasia, with a higher proportion of dysplasia detected (30 vs 21%) and a lower number of biopsies per patient (3.6 vs 7.6).     

Narrow Band Imaging for the Detection of Gastric Intestinal Metaplasia and Dysplasia During Surveillance Endoscopy

Background  

Surveillance of premalignant gastric lesions relies mainly on random biopsy sampling. Narrow band imaging (NBI) may enhance the accuracy of endoscopic surveillance of intestinal metaplasia (IM) and dysplasia. We aimed to compare the yield of NBI to white light endoscopy (WLE) in the surveillance of patients with IM and dysplasia.     

Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia

AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS:We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori ) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI:67-92), a specificity of 96% (95%CI:93-99), a positive predictive value of 84% (95%CI:73-96), a negative predictive value of 95% (95%CI:92-98), and an accuracy of 93% (95%CI:90-97). The NBI-ME examination overlooked GIM in 8 cases, but the GI     

Comparison between the Linked Color and White Light Imaging Combined Score in the Evaluation of High-Risk Population of Gastric Cancer

Background: For patients undergoing gastroscopy, it is necessary to judge whether there is Helicobacter pylori infection, atrophy/intestinal metaplasia. This study aimed to evaluate and compare the light color imaging (LCI) and white light imaging (WLI) combined score during gastroscopy.Methods: Each included patient underwent normalized gastroscopy with WLI and LCI, and all notable findings were photographed. Four endoscopists reviewed the endoscopic images of each patient. The clinical information, results of the H. pylori tests were unavailable at review. The total LCI and WLI scores of each patient were calculated and their detection in high-risk populations of gastric cancer were evaluated. The diagnostic values of LCI and WLI for intestinal metaplasia were also calculated.Results: In total, 392 patients were included in the study. The degree of inflammation and proportion of active inflammation cases were significantly higher in the H. pylori gastritis group than in the non-H. pylori gastritis group; their endoscopic manifestations were also different. The LCI combined score improved the diagnostic value of each individual observation index in the diagnosis of H. pylori infection compared with the WLI combined score. The sensitivity, specificity, and accuracy were 91.9% (91.9% vs 81.5%), 91.1% (91.1% vs 80.2%), and 95.8% (95.8% vs 93.2%), respectively. The accuracy of LCI in the diagnosis of intestinal metaplasia was higher than that of WLI (83.4% vs 69.6%).Conclusion: The LCI and LCI combined score improved the diagnosis of H. pylori gastritis and intestinal metaplasia, and it is considered valuable in identifying the high-risk population of gastric cancer.     

The diagnostic value of confocal laser endomicroscopy for gastric cancer and precancerous lesions among Asian population: a system review and meta-analysis

Objective: The objective of this study is to evaluate the diagnostic value of confocal laser endomicroscopy (CLE) in detection of gastric cancer (GC), gastric intraepithelial metaplasia (GIM), and gastric intraepithelial neoplasia (GIN) lesions.

Method: PubMed, the Cochrane Library, and Wangfang databases were searched to include eligible articles about CLE in detection of gastric lesions. After study selection, quality assessment and data extraction conducted by two reviewers independently, meta-analysis was performed by Meta-Disc 1.4. The pooled sensitivity and specificity was calculated, receiver operating characteristic (ROC) curve was constructed, and the area under ROC curve (AUC) was calculated.

Results: Twenty-three studies evaluating the diagnostic value of CLE were included. For the diagnosis of GC lesions, the pooled sensitivity, specificity, and AUC were 91% (88–94%), 99% (99–99%), and 0.9513, respectively. For the diagnosis of lesions, the pooled sensitivity, specificity, and AUC were 92% (90–94%), 97% (96–98%), and 0.9774, respectively. For the diagnosis of GIN lesions, the pooled sensitivity, specificity and AUC were 81% (75–85%), 98% (97–98%), and 0.9204, respectively.

Conclusions: CLE can provide an accurate diagnosis with high sensitivity and specificity for GC, GIM, and GIN lesions. The results should be confirmed by well-designed, multi-centered, randomized controlled, and double blinded trials with large samples.     

Role of digital chromoendoscopy and confocal laser endomicroscopy for gastric intestinal metaplasia and cancer surveillance

In Japan and countries such as South Korea and Tai-wan, China, the standard technique for detecting earlygastric cancer (EGC) is chromoendoscopy. This technique involves a magnified endoscope and the use ofan indigo-carmine spray to distinguish between EGCand non-EGC areas. However, this technique is notwidely adopted in many parts of the world. One important reason for limited use is that this technique needsan experienced endoscopist to interpret the imagesduring the procedure. In addition, the sensitivity for detecting gastric intestinal metaplasia (GIM), a precancerous lesion of EGC, is graded as suboptimal. Moreover,the requirement of a cumbersome spraying method isinconvenient and needs preparation time. Easier digitalchromoendoscopy techniques, such as Narrow-bandImaging and Flexible spectral Imaging Color Enhancement, have been reported to facilitate targeted GIM and EGC biopsy. They provide higher sensitivities over conventional white light endoscopy. Recently, the noveltechnology of confocal laser endomicroscopy has been introduced as a high-magnification (1000 ×) real-time evaluation for many early gastrointestinal (GI) cancersand precancerous GI lesions, including colonic polyp,Barrett’s esophagus, and GIM. The advantage of this technique is that it can be used as an in vivo confirmation of the presence of GIM and EGC during endoscopic surveillance. This review aims to explain the current information on the usefulness of digital chromoendos-copy and confocal laser endomicroscopy for evaluating GIM and EGC during endoscopic surveillance and the possible future role of these techniques for GI cancerscreening programs.     

Can neopterin be a useful immune biomarker for differentiating gastric intestinal metaplasia and gastric atrophy from non-atrophic non-metaplastic chronic gastritis?

IntroductionHelicobacter pylori (H. pylori) is closely related to pre-neoplastic lesions such as gastric atrophy (GA), gastric intestinal metaplasia (GIM) and eventually gastric cancer (GC). The diagnosis of GIM and GA is usually based on endoscopic and histopathological features. Nowadays, there are no recognized good serological markers of GIM and GA. Neopterin is an important marker of cellular inflammation. In this study, we aimed to comparatively evaluate C-reactive protein (CRP) and neopterin levels in patients with GIM, GA and chronic gastritis, and to show the increased serum neopterin levels in GIM and GA according to non-atrophic and non-metaplastic chronic gastritis.Patients and methods98 patients with GIM and 68 patients with GA and 70 patients with non-atrophic non-metaplastic gastritis were included in the study. CRP and neopterin levels were assessed in patients and controls.ResultsCRP and neopterin levels were significantly higher in patients with GIM and GA than in controls (p < 0.05 and p < 0.001, respectively). A multiple logistic regression analysis showed that high levels of serum neopterin were positively correlated with GIM and GA. According to the ROC curve analysis, the best cut-off value to differentiate between patients with GIM and/or GA from controls was ≥10.15 nmol/l (p < 0.001) for serum neopterin levels and ≥1.95 mg/l (p < 0.001) for serum CRP levels.DiscussionCRP and neopterin levels are significantly increased in GIM and GA. Neopterin may be a useful biomarker and diagnostic test for detecting GIM and GA in clinical practice. CRP levels may be helpful for this observation.     

GASTRIC CANCER DETECTED AFTER HELICOBACTER PYLORI ERADICATION

Background: Helicobacter pylori is associated with progression to gastric cancer. However, it is still unclear whether eradication therapy can prevent the development of gastric cancer. Methods: Subjects were 242 patients in whom success in eradication of Helicobacter pylori had been continuous for more than 3 years. Clinical, endoscopic and histological findings were compared retrospectively between those who developed gastric cancer (cancer group) and those who did not (non‐cancer group). Clinical features of each cancer case were also evaluated. Results: Gastric cancer was found in six of the 242 subjects (2.5%) during a mean follow‐up period of 4.6 years (range: 3.0–7.0). The mean age of the cancer group tended to be higher than that of the non‐cancer group. Endoscopy revealed a more severe grade of gastric corpus atrophy in the cancer group, and histological findings showed that the degree of intestinal metaplasia in the upper corpus was higher in the cancer group. Four of the six cancers were located in the gastric antrum. All were early cancers and five were of 0‐IIc type endoscopically. All were intestinal type histologically. Conclusions: Gastric cancer was discovered at a rate of 2.5% during the mean follow‐up period of 4.6 years after H. pylori eradication. Careful endoscopic follow up is necessary even after successful eradication, especially in cases characterized by an endoscopically high grade of gastric atrophy and pathologically severe intestinal metaplasia at the upper corpus.     

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

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?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.     

Comparison of intestinal metaplasia in gastric cardia and Barrett's esophagus

OBJECTIVE: To evaluate and compare the pathological features and immunostaining pattern (cytokeratin 7 (CK‐7), mucin core peptide 1 (Muc‐1)) in Barrett's esophagus (BE) and cardiac intestinal metaplasia (CIM). METHODS: According to endoscopic diagnosis, patients with gastric cardiac inflammation and BE were selected from March 2008 to February 2009 in Renji Hospital, Shanghai Jiaotong University School of Medicine. Those patients who had histological findings of intestinal metaplasia (82 cases of CIM and 64 special type BE) were enrolled in our study. Hematoxylin–eosin, periodic acid‐Schiff and Alcian blue staining and an immunohistochemical examination (CK‐7, Muc‐1) were undertaken in all of them. RESULTS: Squamous mucosa overlying the columnar crypts with intestinal metaplasia, also called buried metaplasia, was often found in the BE group (56.2%), mainly as an incomplete type (85.9%). Inflammation in the gastric antrum was more severe in the CIM group (45.1% vs 26.6%), in contrast, esophagitis was more severe in the BE group (53.1% vs 35.4%). CK‐7 was highly expressed in the BE group (84.4%) in contrast to the CIM group (37.8%). There was no difference in the expression of Muc‐1 in these two kinds of intestinal metaplasia (14.1% vs 19.5%). CONCLUSIONS: Buried intestinal metaplasia, mainly as an incomplete type, is the major predominant type of BE. The degree of inflammation in the gastric antrum and esophagus can differentiate BE from CIM to some extent. CK‐7 immunohistochemical staining can help identify BE and CIM but Muc‐1 cannot.     

Intestinal metaplasia at the squamocolumnar junction in patients attending for diagnostic gastroscopy

Background—The incidence of adenocarcinoma of theoesophagus and gastric cardia is increasing rapidly. Barrett'soesophagus is the major risk factor. Intestinal metaplasia at thesquamocolumnar junction in the absence of Barrett's oesophagus iscommon but its relation to adenocarcinoma and gastro-oesophageal refluxdisease is unclear.
Aims—To study the prevalence and clinical,endoscopic, and histological associations of intestinal metaplasia atthe squamocolumnar junction.
Methods—Biopsy specimens were taken from 120 randomly selected patients undergoing routine diagnostic endoscopy.Eight biopsy specimens, taken from above and below the squamocolumnarjunction, gastric fundus, and gastric antrum, were stained withhaematoxylin/eosin, alcian blue/periodic acid-Schiff, and Gimenez, andgraded independently by one pathologist.
Results—Intestinal metaplasia at thesquamocolumnar junction was found in 21 patients (18%). Metaplasia wasassociated with increasing age (p<0.01) and antral intestinalmetaplasia (p=0.04). Logistic regression analysis revealed that age wasthe only independent predictor (p<0.01). There was no association withsymptomatic, endoscopic, or histological markers of gastro-oesophagealreflux disease.
Conclusions—Intestinal metaplasia at thesquamocolumnar junction is a common finding. It is associated withincreasing age but not gastro-oesophageal reflux disease.

Keywords:intestinal metaplasia; Barrett's oesophagus; gastro-oesophageal reflux disease; oesophagus; gastric cardia; adenocarcinoma

     

Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia

BACKGROUND: The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia may lead to early diagnosis of gastric cancer. However, to-date no cost-effective model has been proposed. Improved endoscopic examination using magnification chromoendoscopy together with non-invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost-effectiveness of a follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen. METHODS: A cohort of patients with lesions as severe as atrophic chronic gastritis were followed-up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost-effectiveness of this follow-up model versus its absence. Transition rates were considered time-independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed. RESULTS: A total of 100 patients were successfully followed-up over 3 years. Seven cases of dysplasia were diagnosed during follow-up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio <3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3-yearly basis would cost 455 euros per quality-adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost 1868 euros per QALY for patients with extensive intestinal metaplasia. CONCLUSIONS: The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost-effective if improved accurate endoscopic examination of gastric mucosa together with non-invasive assessment of gastric mucosal status are used to identify individuals at high-risk for development of gastric cancer.     

Optical enhancement imaging versus acetic acid for detecting gastric intestinal metaplasia: A randomized,comparative trial

Background and aimsThe diagnosis of gastric intestinal metaplasia (GIM) is still challenging. Optical Enhancement technology (OE) may improve the detection of GIM. We compared detection of GIM with OE, acetic acid and the Sydney biopsy protocol in a surveillance population.MethodsConsecutive patients with atrophic gastritis or known GIM were prospectively included. The stomach was examined with high definition whitelight endoscopy, followed by OE or acetic acid with targeted biopsies (1:1 randomisation). Subsequently, five random biopsies were taken according to the updated Sydney system.ResultsA total of 154 patients were randomized. Higher proportions of patients with GIM were detected by OE and acetic acid versus random biopsy (60.5% vs 35.5%, 67.1% vs 31.5%, respectively; P < 0.0001 for both comparisons). The combined use of targeted biopsies and random biopsies provides high diagnostic yields for GIM (78.9% in OE group and 83.6% in acetic acid group). In addition, the proportion of extensive GIM was significantly increased when image enhanced endoscopy was used instead of white light endoscopy (P = 0.029, P = 0.048, respectively).ConclusionsOE and acetic acid showed comparable results diagnosing GIM in the study. Targeted biopsies plus random biopsies should be used complementary in high risk populations.     

Prevalence of Intestinal Metaplasia in Helicobacter pylori Gastritis

Eidt S, Stolte M. Prevalence of intestinal metaplasia in Helicobacter pylori gastritis. Scand J Gastroenterol 1994;29:607-610

Background: The prevalence of intestinal metaplasia (IM) in underlying Helicobacter pylori gastritis was studied in 1446 patients.

Methods: Antral and body mucosa biopsy specimens (stains: hematoxylin and eosin, Warthin-Starry) were taken from five groups of patients: gastritis with no lesions, gastritis with duodenal, pyloric, or gastric ulcers or with chronic antral erosions.

Results: The prevalence of IM was higher in the antral than in the body mucosa (22.9% versus 2.8%; p < 0.001). Patients with IM had a higher mean age than those without IM in the overall group (p < 0.01). IM could be detected with the highest frequency in patients with gastric ulcers (p < 0.001).

Conclusions: The higher prevalence of IM in the antral mucosa–the preferred location of gastric carcinomas–further supports the postulated association of H. pylori and gastric carcinoma. The various prevalences of IM might contribute to explaining the different probabilities of gastric carcinoma developing in the groups investigated.