title: Flexible spectral imaging color enhancement plus probe-based confocal laser endomicroscopy for gastric intestinal metaplasia detection.
abstract: OBJECTIVE
  Probe-based confocal laser endomicroscope (pCLE) has been applied for the early detection and confirmation of many gastrointestinal neoplasms; however, its use in gastric intestinal metaplasia (GIM) detection has not yet been validated. The objective of this study was to assess the diagnostic yield of magnifying flexible spectral imaging color enhancement (ME-FICE) plus pCLE for GIM detection.
  
  
  METHODS
  Sixty patients with previous histology confirmed as GIM underwent a surveillance EGD. Standard and 100× ME-FICE were used as a screening mode to depict GIM by light-blue crest, large long crest, and villous pattern criteria. Then, pCLE was followed to confirm the presence of GIM. In each patient, two biopsies were obtained from one positive area, and the other two were taken from the negative area. All specimens were interpreted by a clinically blinded pathologist. The reading results by ME-FICE and by ME-FICE plus pCLE were assessed for sensitivity, specificity, positive predictive value, negative predictive value (NPV), false-positive rate, false-negative rate, and accuracy.
  
  
  RESULTS
  Of the 59 areas suspicious for GIM in 45 patients, 44 areas were confirmed as GIM by histology. The overall criteria from ME-FICE plus pCLE provided the highest sensitivity, specificity, positive predictive value, NPV, and accuracy at 96%, 90%, 86%, 97%, and 92%, respectively. There were two false-negatives (4%) and seven false-positives (10%). No early gastric cancer was detected in any.
  
  
  CONCLUSIONS
  Combining ME-FICE with pCLE provides high sensitivity and NPV for GIM detection. The prompt histology reading by this technique may avoid unnecessary biopsy (Clinical trial registration number: NCT01489397).
authors: Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Thailand.
authors: Rapat
authors: R
authors: Pittayanon
authors: Rungsun
authors: R
authors: Rerknimitr
authors: Naruemon
authors: N
authors: Wisedopas
authors: Wiriyaporn
authors: W
authors: Ridtitid
authors: Pradermchai
authors: P
authors: Kongkam
authors: Sombat
authors: S
authors: Treeprasertsuk
authors: Phonthep
authors: P
authors: Angsuwatcharakon
authors: Varocha
authors: V
authors: Mahachai
authors: Pinit
authors: P
authors: Kullavanijaya
mesh_terms: D003116:Color; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007422:Intestines / Q000473:pathology*; D008297:Male; D008679:Metaplasia; D018613:Microscopy, Confocal; D008875:Middle Aged; D013270:Stomach / Q000473:pathology*