Confocal laser endomicroscopy for in vivo detection of gastric intestinal metaplasia: a randomized controlled trial.
OBJECTIVE
Gastric intestinal metaplasia (GIM) is associated with a risk for development of intestinal-type gastric cancer. This study aimed to compare the diagnostic yield of GIM from confocal laser endomicroscopy (CLE) and white light endoscopy (WLE).


METHODS
In a prospective, double-blind, randomized study, patients were randomly assigned to receive either CLE with targeted biopsies (group A) or WLE with a standard biopsy protocol (group B).


RESULTS
A total of 168 patients were finally analyzed (group A 85, group B 83). On a per-patient analysis, the diagnostic yields of GIM (including GIM with gastric intraepithelial neoplasia [GIN]) for groups A and B were 44.71 % and 31.33 %, respectively (P = 0.074). On a per-biopsy analysis, CLE-targeted biopsy gave a significantly higher diagnostic yield of GIM compared with WLE and standard biopsy, at 65.70 % (113 /172 biopsies) versus 15.73 % (81 /515 biopsies) (P < 0.001). Moreover, the diagnostic yield of the operative link on gastric intestinal metaplasia (OLGIM) assessment stages III and IV was higher at 20.93 % (36 /172 biopsies) in group A versus 4.08 % (21 /515 biopsies) in group B (P < 0.001). In addition, use of CLE-guided biopsy significantly decreased by 68 % (P < 0.001) the mean number of biopsies required per patient.


CONCLUSIONS
CLE with targeted biopsies is superior to WLE with standard biopsies for the detection and surveillance of GIM. The number of biopsies needed to confirm GIM is about one third of that needed with WLE with standard biopsies.
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Zhen
Z
Li
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Xiu-Li
XL
Zuo
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Tao
T
Yu
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Xiao-Meng
XM
Gu
Department of Pathology, the Second Affiliated Hospital, Shandong University, Jinan, China.
Cheng-Jun
CJ
Zhou
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Chang-Qing
CQ
Li
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Rui
R
Ji
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Yan-Qing
YQ
Li
D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D007150:Immunohistochemistry; D007422:Intestines / Q000473:pathology*; D008297:Male; D008679:Metaplasia / Q000473:pathology; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*