Reliability and accuracy of blue light imaging for staging of intestinal metaplasia in the stomach.

Castro R1, Rodriguez M1, Libânio D1,2, Esposito G3, Pita I1, Patita M4, Santos C2,5, Pimentel-Nunes P1,5,6, Dinis-Ribeiro M1,2,5.

Scand J Gastroenterol. 2019 Nov 3:1-5. doi: 10.1080/00365521.2019.1684555. [Epub ahead of print]

Background and aims: An endoscopic grading system (EGGIM) using narrow-band-imaging (NBI) has shown to accurately identify patients with extensive gastric intestinal metaplasia (GIM). However, description with alternative systems such as blue-light-imaging (BLI) is limited. The aim of this study is to determine the reliability and accuracy of BLI-bright regarding diagnosis and staging of GIM.

Methods: Reliability of WLE (white-light-endoscopy) and BLI among 6 observers was assessed using a standard classification based on endoscopic images. Afterward, 37 patients were submitted to gastroscopy using FujifilmEG-760Z and endoscopists had to determine EGGIM score using BLI-bright and to perform gastric biopsies for operative-link-of-gastric-intestinal-metaplasia (OLGIM) calculation. BLI-bright accuracy was determined by comparing results with prior EGGIM scores with NBI and current OLGIM.

Results: Compared with WLE, the interobserver reliability between observers was substantially better with BLI (Weighted Kappa: 0.8 vs 0.41). There was an 84% agreement between BLI and NBI assessing EGGIM intervals (EGGIM 0-4vs5-10). The area under the ROC curve was 0.90 (95%CI: 0.79-1.0) using the cut-off of EGGIM > 4 to determine advanced GIM, with a sensitivity of 100% (95%CI: 88-100%).

Discussion: BLI-bright is reliable for the diagnosis of gastric intestinal metaplasia and agrees significantly with NBI evaluation. Preliminary data suggests high sensitivity for identifying patients with increased risk of gastric cancer.

1 Gastroenterology Department, Oncology Portuguese Institute of Porto, Porto, Portugal
2 Faculty of Medicine, CINTESIS, University of Porto, Porto, Portugal
3 Department of Medical-Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, ltaly
4 Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal
5 Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal
6 Faculty of Medicine, Department of Surgery and Physiology, University of Porto, Porto, Portugal