Narrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial
Narrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial
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DOI：
10.1016/j.gie.2017.03.1528
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发表时间：
2017-11-01
影响因子：
7.7
通讯作者：
Laine, Loren
中科院分区：
文献类型：
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作者：
Buxbaum, James L.;Hormozdi, David;Laine, Loren
背景与目的：胃肠化生（GIM）是胃癌的前兆。窄带成像（NBI）可以提高GIM的检出率。我们比较了高清晰度白光（HD-WL）内窥镜、NBI和胃癌风险增加人群的定位活检对GIM的检测。方法：接受上腔镜检查的患者由一名内镜医师进行HD-WL检查，随后由另一名对HD-WL结果不知情的内镜医师进行NBI检查。由研究协调员记录HDWL和NBI检测到的异常位置，并在NBI后对异常区域进行靶向活检。随后，每位患者进行5次定位活检。活检标本由不知道获取方式的病理学家读取。主要终点是GIM患者的比例。结果：我们纳入了112例患者：107例（96%）为西班牙裔或亚洲人，34例（30%）患有GIM。与HD-WL（10/34[29%]）相比，NBI（22/34[65%]）和mapping（26/34[76%]）检测到GIM患者的比例更高（两种比较的P < 0.005）。只有6例患者通过NBI检测到GIM， 10例患者仅通过定位活检检测到GIM；没有患者单独通过HD-WL检测到GIM。NBI（30/57[53%]）和定位活检（38/57[67%]）也比HD-WL（16/57[28%]）检测到更高比例的GIM位点（两种比较均P < 0.005）。每位患者活检的中位数（5次）明显高于NBI（2次）或HD-WL（1次）。结论：HD-WL内镜不足以检测胃癌高危患者的GIM。应使用nbi靶向活检加定位活检。
Background and Aims: Gastric intestinal metaplasia (GIM) is a gastric cancer precursor. Narrow-band imaging (NBI) may improve detection of GIM. We compared detection of GIM with high-definition white-light (HD-WL) endoscopy, NBI, and mapping biopsies in a population with increased gastric cancer risk.Methods: Patients undergoing upper endoscopy had HD-WL examination by 1 endoscopist, followed by an NBI examination by a second endoscopist blinded to HD-WL findings. The location of abnormalities detected by HDWL and NBI were recorded by a research coordinator, and targeted biopsies of abnormal areas were performed after NBI. Subsequently, 5 mapping biopsies were performed per patient. Biopsy specimens were read by a pathologist blinded to mode of acquisition. The primary outcome was the proportion of patients with GIM.Results: We enrolled 112 patients: 107 (96%) were Hispanic or Asian, and 34 (30%) had GIM. Higher proportions of patients with GIM were detected by NBI (22/34 [65%]) and mapping (26/34 [76%]) versus HD-WL (10/34 [29%]) (P < .005 for both comparisons). GIM was detected by NBI in only 6 patients and only by mapping biopsy in 10 patients; no patient had GIM detected solely by HD-WL. Higher proportions of sites with GIM also were detected with NBI (30/57 [53%]) and mapping biopsies (38/57 [67%]) than HD-WL (16/57 [28%]) (P < .005 for both comparisons). The median number of biopsies per patient with mapping biopsies (5) was significantly higher than with NBI (2) or HD-WL (1).Conclusions: HD-WL endoscopy is insufficient for detection of GIM in patients at increased risk for gastric cancer. NBI-targeted biopsies plus mapping biopsies should be used.