Jonathan R White1,2, Sarmed S Sami3, Dona Reddiar1,2, Jayan Mannath4, Jacobo Ortiz-Fernández-Sordo1,2, Sabina Beg1,2, Robert Scott1,2, Prarthana Thiagarajan1,2, Saqib Ahmad5, Adolfo Parra-Blanco1,2, Madhavi Kasi1,2, Emmanouil Telakis6, Alyshah A Sultan7, Jillian Davis8, Adam Figgins8, Philip Kaye8, Karen Robinson1,2, John C Atherton1,2, Krish Ragunath1,2. 1. a 1 NIHR Nottingham Biomedical Research Centre , Nottingham University Hospitals NHS Trust and The University of Nottingham , Nottingham , UK. 2. b 2 Nottingham Digestive Diseases Centre , The University of Nottingham , Nottingham , UK. 3. c 3 Mayo Clinic Division of Gastroenterology and Hepatology , Rochester , MN, USA. 4. d 4 Department of Gastroenterology , University Hospitals Coventry and Warwickshire NHS Trust , Coventry , UK. 5. e 5 Sherwood Forest Hospitals NHS Foundation Trust, Kings Mill Hospital , Nottinghamshire , UK. 6. f 6 Department of Gastroenterology , Hellenic Red Cross Hospital , Athens , Greece. 7. g 7 Research Institute for Primary Care and Health Sciences, Primary Care Sciences , Keele University , Staffordshire , UK. 8. h 8 Department of Pathology , Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus , Nottingham , UK.
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 < 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.
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. pylorigastritis 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. pylorigastritis 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.
Entities:
Keywords:
gastritis; Endoscopy; gastric atrophy; intestinal metaplasia; narrow band imaging; serology; white light endoscopy