Dohi O1, Yagi N2, Naito Y1, Fukui A4, Gen Y4, Iwai N1, Ueda T1, Yoshida N1, Kamada K1, Uchiyama K1, Takagi T1, Konishi H1, Yanagisawa A4, Itoh Y1.
Gastrointest Endosc. 2018 Sep 3. pii: S0016-5107(18)33008-6. doi: 10.1016/j.gie.2018.08.049. [Epub ahead of print]
Background and aims: Blue laser imaging (BLI)-bright (BLI-bright) has shown promise as a more useful tool for detection of early gastric cancer (EGC) than white-light imaging (WLI). However, the diagnostic performance of BLI-bright in the detection of EGC has not been investigated. We aimed to compare real-time detection rates of WLI with that of BLI-bright for EGC.
Methods: This was a prospective, randomized, controlled study in 2 Japanese academic centers. We investigated 629 patients undergoing follow-up endoscopy for atrophic gastritis with intestinal metaplasia or surveillance after endoscopic resection of EGC. Patients were randomly assigned to receive primary WLI followed by BLI-bright or primary BLI-bright followed by WLI. The real-time detection rates of EGC were compared between primary WLI and primary BLI-bright.
Results: Of 298 patients in each group, the real-time detection rate of EGC with primary BLI-bright was significantly greater than that with primary WLI (93.1% vs 50.0%; p = 0.001). Primary BLI-bright had a significantly greater ability to detect EGCs in patients with a history of endoscopic resection for EGC, an HP-negative stomach after eradication therapy, lesions with an open-type atrophic border, lesions in the lower third of the stomach, depressed-type lesions, small lesions measuring <10 mm and 10 to 20 mm in diameter, reddish lesions, well-differentiated adenocarcinomas, and lesions with a depth of invasion of T1a.
Conclusions: BLI-bright has a higher real-time EGC detection rate than WLI. BLI-bright should be performed during surveillance endoscopy in patients at high risk for EGC.
1 Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
2 Department of Gastroenterology and Hepatology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
3 Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu, Japan
4 Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan