Lyutakov I.*, Nakov R.*, Valkov H.*, Dimov A.**, Penchev P.*, Vladimirov B.*

*Gastroenterology Clinic, University Hospital 'Tsaritsa Yoanna - ISUL', Sofia, Bulgaria,

**Department of Statistics and Econometrics, University of National and World Economy, Sofia, Bulgaria

Presenting author: Lyutakov I.

 

AIMS

To evaluate the sensitivity, specificity and the predictive value of acetic acid-enhanced NBI (AA-NBI) or crystal violet-enhanced NBI (CV-NBI) versus white-light endoscopy (WLE) using endoscopic grading of gastric intestinal metaplasia (EGGIM) and simplified NBI classification compare to Operative Link for Gastritis assessment based on Intestinal Metaplasia (OLGIM/OLGA) assessment in patients referred for upper endoscopy with suspected gastric intestinal metaplasia (GIM).

 

METHODS

In this prospective study we enrolled in 34 patients age 30-75 years with dyspepsia based on presenting signs and symptoms, who underwent upper endoscopy and biopsy of the mucosae in mono-center study at “Tsaritsa Yoanna - ISUL” University Hospital, Sofia, Bulgaria. We divided the patients into 3 groups: 12 patients using WLЕ + random biopsy, 10 patients using CV-NBI and targeted biopsy and 12 patients using AA-NBI and targeted biopsy. The ability of the three different methods to diagnose GIM in these patients was compared. We compare EGGIM and simplified NBI classification with the results from OLGIM/OLGA.

 

RESULTS

Of 34 patients included in the analysis, the diagnosis of GIM was confirmed in 4 (11,8%) and excluded in 30 (88,2%) patients, of which 3 (75%) were diagnosed by AA-NBI and 1 (25%) by CV-NBI as compared to WLE, no patient was identified with random biopsy. Therefore, the overall diagnostic accuracy of chromoendoscopy using EGGIM score is with sensitivity 83.3% and specificity 82.12%, positive predictive values 50% and negative predictive values 95.83% for detecting GIM using OLGIM/OLGA.

 

CONCLUSIONS

AA-NBI and CV-NBI showed high sensitivity, specificity and very high NPV for detecting (diagnosing) GIM in patients with gastric atrophy and significantly higher diagnostic yield compare to WLE+random biopsy. Chromoendoscopy combined with NBI should be used for detecting GIM and can improve the accuracy of endoscopy-targeted biopsies in patients with suspected gastric atrophy. Further bigger studies are needed to establish the efficacy of AA-NBI and CV-NBI.