Guanpo Zhang1,2, Jin Zheng2,3, Linfu Zheng1,2, Shentong Yu4, Chuanshen Jiang1,2, Wulian Lin1,2, Dazhou Li1,2, Lijuan Qu4, Wen Wang1,2
Scand J Gastroenterol. 2021 Jan;56(1):103-110. doi: 10.1080/00365521.2020.1849385. Epub 2020 Nov 24.
Objective: Cumulative evidence suggests that linked color imaging (LCI) can be used to identify gastric intestinal metaplasia (GIM). We aimed to develop endoscopic grading for GIM (EGGIM) with LCI.
Methods: Two hundred and seventy-seven patients who underwent high-resolution white-light gastroscopy followed by LCI for EGGIM estimation were included. LCI was performed for the entire mucosa, and images of five areas each were recorded from the lesser and greater curvatures of the antrum and corpus, and for the incisura. For each area, scores of 0 (no GIM), 1 (focal GIM, ≤30% of the area), and 2 (extensive GIM, >30% of the area) were attributed for 10 points. If GIM was suspected based on endoscopy findings, targeted biopsies were performed; if GIM was not evident, random biopsies were performed according to the Sydney system to estimate the operative link on GIM (OLGIM).
Results: GIM was staged as OLGIM 0, I, II, III, and IV in 136, 70, 37, 28, and 6 patients, respectively. For OLGIM III/IV diagnosis, the area under the receiver operating curve was 0.949 (95% CI 0.916-0.972). EGGIM of 4, with sensitivity and specificity of 94.12% (95% CI 80.3%-99.3%) and 86.42% (95% CI 81.5%-90.5%), respectively, was determined the best cut-off value for identifying OLGIM III/IV patients.
Conclusions: Our findings demonstrated the ability of EGGIM for diagnosing the extent of intestinal metaplasia and showed that EGGIM is related to OLGIM staging. EGGIM of 4 was the best cut-off value for identifying OLGIM III/IV patients.
1 Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, Fujian Medical University, Fuzhou, China
2 Department of Gastroenterology, 900th Hospital of Joint Logistics Support Force, People’s Liberation Army, Fuzhou, China
3 Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
4 Department of Pathology, 900th Hospital of Joint Logistics Support Force, People’s Liberation Army, Fuzhou, China