The accuracy of flexible spectral imaging colour enhancement for the diagnosis of gastric intestinal metaplasia: do we still need histology to select individuals at risk for adenocarcinoma?

BACKGROUND: Targeting biopsies on the basis of visual recognition of mucosal changes in the stomach instead of the currently accepted random biopsy sampling may be attractive. AIM: The aim of this study was to evaluate the accuracy of endoscopic findings using flexible spectral imaging colour enhancement (FICE) for intestinal metaplasia (IM) in the gastric mucosa.
METHODS: A consecutive cohort of 126 individuals aged over 50 years (27% men) was subjected to upper endoscopy using FICE. Histological assessment (per patient and per biopsy) was considered the gold standard to accuracy estimates.
RESULTS: Histological assessment revealed IM in 50% of the individuals [OLGIM (operative link on gastric intestinal metaplasia assessment) stages I-IV]. Overall, endoscopy presented sensitivities, specificities, positive likelihood ratio, negative likelihood ratio and accuracies per patient of 60% [95% confidence interval (95% CI) 48-72], 87% (95% CI 79-95), 4.7 (95% CI 2.4-93), 0.45 (95% CI 0.33-0.62) and 74% (95% CI 0.66-0.82), respectively, for IM diagnosis and 71% (95% CI 37-100), 87% (95% CI 79-95), 5.6 (95% CI 2.5-12.5), 0.32 (95% CI 0.10-1.0) and 86% (95% CI 77-94), respectively, for selecting individuals with OLGIM (III-IV). The proportions of agreement (and κ values) for IM in the antrum and the corpus were 75% (0.37) and 81% (0.19), respectively.
CONCLUSION: FICE endoscopy yielded favourable results in the endoscopic diagnosis of IM of the gastric mucosa, and this is a very practical and easy method to use in daily clinical practice for unselected patients. Our study demonstrated a good specificity for FICE endoscopy to detect IM in the stomach. Further improvement in disseminating and training of this assessment is required to improve the reliability.