Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 14, 2011; 17(10): 1336-1342
Published online Mar 14, 2011. doi: 10.3748/wjg.v17.i10.1336
Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia
Rungsun Rerknimitr, Boonlert Imraporn, Naruemon Klaikeaw, Wiriyaporn Ridtitid, Sukprasert Jutaghokiat, Yuwadee Ponauthai, Pradermchai Kongkam, Pinit Kullavanijaya
Rungsun Rerknimitr, Boonlert Imraporn, Wiriyaporn Ridtitid, Sukprasert Jutaghokiat, Yuwadee Ponauthai, Pradermchai Kongkam, Pinit Kullavanijaya, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10310, Thailand
Naruemon Klaikeaw, Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Rerknimitr R designed and performed the research, searched the literature, and wrote the paper; Imraporn B performed the research, collected and analyzed the data, and wrote the paper; Ridtitid W, Jutaghokiat S, and Ponauthai Y collected data and recruited patients; Klaikeaw N read the pathology; Kongkam P and Kullavanijaya P reviewed the manuscript and provided feedback.
Supported by The Gastroenterological Association of Thailand: grant for Gastroenterology Fellow 2007
Correspondence to: Rungsun Rerknimitr, MD, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. rungsun@pol.net
Telephone: +66-2-2564265 Fax: +66-2-2527839
Received: September 6, 2010
Revised: December 16, 2010
Accepted: December 23, 2010
Published online: March 14, 2011
Abstract

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 histology results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of positive test (LR+). The number of early gastric cancer cases detected was also reported.

RESULTS: NBI targeted biopsy was performed in 38 and 26 patients during the first and second surveillance endoscopies, respectively. There were 2 early gastric cancers detected in the first endoscopy. No cancer was detected from the second study. Surgical and endoscopic resections were successfully performed in each patient. Sensitivity, specificity, PPV, NPV, and LR+ of all 3 endoscopic criteria during the first/second surveillances were 78.8%/91.3%, 82.5%/89.1%, 72.8%/77.8%, 86.8%/96.1, and 4.51/8.4, respectively. LBC provided the highest LR+ over VP and LLC.

CONCLUSION: Non-sequential NBI is useful for GIM targeted biopsy. LBC provides the most sensitive reading. However, the optimal duration between two surveillances requires further study.

Keywords: Gastric intestinal metaplasia; Gastric cancer; Non-sequential narrowband imaging