title: Comparison of probe-based confocal endomicroscopy with virtual chromoendoscopy and white-light endoscopy for diagnosis of gastric intestinal metaplasia.
abstract: OBJECTIVE
  We prospectively compared the diagnostic performance of autofluorescence imaging (AFI), magnifying narrow band imaging (mNBI), and probe-based confocal laser endomicroscopy (pCLE) with white light endoscopy (WLE) for the diagnosis of gastric intestinal metaplasia (GIM), using histology as the "gold standard."
  
  
  METHODS
  Chinese >50 years old with history of GIM were prospectively recruited. All subjects underwent WLE, followed by AFI and NBI, and finally pCLE. Patients were randomized to undergo either AFI before NBI or vice versa. In each patient, a minimum of six sites (antrum lesser and greater curve, body lesser and greater curve, incisura, cardia, and any lesion) were each examined by WLE, AFI, NBI, and pCLE. The diagnoses were made real-time. Biopsies for histology were taken from all examined sites. pCLE videos also were reviewed off-site. Analysis was performed per-site.
  
  
  RESULTS
  A total of 125 sites in 20 patients were examined. For diagnosing GIM, real-time pCLE had better sensitivity (90.9 vs. 37.9%, p < 0.001) and accuracy (88.0 vs. 64.8%, p < 0.001) compared with WLE. Sensitivity (90.9 vs. 68.2%, p = 0.001), specificity (84.7 vs. 69.5%, p = 0.042), and accuracy (88 vs. 68.8%, p < 0.001) of real-time pCLE were better than AFI. Sensitivity, specificity, and accuracy of real-time pCLE and mNBI for diagnosing GIM were similar. Off-site pCLE had significantly better accuracy for diagnosing GIM compared to WLE, AFI, and mNBI. Off-site pCLE had superior specificity (94.9 vs. 84.7%, p = 0.031) and accuracy (95.2 vs. 88.0%, p = 0.012) compared with real-time pCLE.
  
  
  CONCLUSIONS
  pCLE was superior to AFI and WLE for diagnosing GIM. Off-site review improved performance of pCLE.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Health System, 10 Kent Ridge Crescent, Singapore, 119260, Singapore, lee_guan_lim@nuhs.edu.sg.
authors.forename: Lee Guan
authors.initials: LG
authors.lastname: Lim
authors.forename: Khay Guan
authors.initials: KG
authors.lastname: Yeoh
authors.forename: Supriya
authors.initials: S
authors.lastname: Srivastava
authors.forename: Yiong Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Ming
authors.initials: M
authors.lastname: Teh
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
mesh_terms: D001706:Biopsy; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000175:diagnosis*; D014741:Video Recording
references.citation: Endoscopy. 2006 Aug;38(8):819-24
references.pmid: 17001572
references.citation: Endoscopy. 2010 Jun;42(6):435-40
references.pmid: 20506064
references.citation: Clin Gastroenterol Hepatol. 2006 Aug;4(8):979-87
references.pmid: 16843068
references.citation: Gastroenterology. 2010 Mar;138(3):834-42
references.pmid: 19909747
references.citation: Endoscopy. 2011 May;43(5):419-24
references.pmid: 21360422
references.citation: Clin Gastroenterol Hepatol. 2006 Jun;4(6):709-16
references.pmid: 16765306
references.citation: Endoscopy. 2008 Jul;40(7):547-53
references.pmid: 18618938
references.citation: Cancer Res. 1992 Dec 15;52(24):6735-40
references.pmid: 1458460
references.citation: Gastrointest Endosc. 2011 Jun;73(6):1141-7
references.pmid: 21492850
references.citation: J Gastroenterol. 2010;45(1):45-51
references.pmid: 19876586
references.citation: Gastrointest Endosc. 2010 Jul;72(1):19-24
references.pmid: 20381042
references.citation: Gut. 2008 Dec;57(12):1648-53
references.pmid: 18755886