Gastric intestinal metaplasia assessment between linked color imaging based on endoscopy and pathology

Abstract

Objective

Cumulative evidence suggests that linked color imaging (LCI) can be used to identify gastric intestinal metaplasia (GIM). We aimed to develop endoscopic grading for GIM (EGGIM) with LCI.

Methods

Two hundred and seventy-seven patients who underwent high-resolution white-light gastroscopy followed by LCI for EGGIM estimation were included. LCI was performed for the entire mucosa, and images of five areas each were recorded from the lesser and greater curvatures of the antrum and corpus, and for the incisura. For each area, scores of 0 (no GIM), 1 (focal GIM, ≤30% of the area), and 2 (extensive GIM, >30% of the area) were attributed for 10 points. If GIM was suspected based on endoscopy findings, targeted biopsies were performed; if GIM was not evident, random biopsies were performed according to the Sydney system to estimate the operative link on GIM (OLGIM).

Results

GIM was staged as OLGIM 0, I, II, III, and IV in 136, 70, 37, 28, and 6 patients, respectively. For OLGIM III/IV diagnosis, the area under the receiver operating curve was 0.949 (95% CI 0.916–0.972). EGGIM of 4, with sensitivity and specificity of 94.12% (95% CI 80.3%–99.3%) and 86.42% (95% CI 81.5%–90.5%), respectively, was determined the best cut-off value for identifying OLGIM III/IV patients.

Conclusions

Our findings demonstrated the ability of EGGIM for diagnosing the extent of intestinal metaplasia and showed that EGGIM is related to OLGIM staging. EGGIM of 4 was the best cut-off value for identifying OLGIM III/IV patients.

Keywords:

• Stomach neoplasms
• linked color imaging
• gastric intestinal metaplasia
• operative link of gastric intestinal metaplasia (OLGIM
• )
• endoscopic grading of gastric intestinal metaplasia (EGGIM)

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Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The present research was financially supported by National Key Research & Development Program of China [Grant No: 2017YFC0908302] and Science and Technology Innovation Joint Fund Project of Fujian Province [Grant No: 2018Y9116] and The Hospital Fund for Distinguished Young Scholars [Grant No: 2015Q06].