Narrow band imaging and serology in the assessment of premalignant gastric pathology |
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Authors: | Jonathan R. White Sarmed S. Sami Dona Reddiar Jayan Mannath Jacobo Ortiz-Fernández-Sordo Sabina Beg |
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Affiliation: | 1. NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK;2. Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, UK;3. jonathan.white@nottingham.ac.uk;5. Mayo Clinic Division of Gastroenterology and Hepatology, Rochester, MN, USA;6. Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK |
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Abstract: | AbstractBackground: 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. |
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Keywords: | Endoscopy narrow band imaging white light endoscopy serology H. pylori gastritis gastric atrophy intestinal metaplasia |
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