title: In vivo histopathology using endocytoscopy for non-neoplastic changes in the gastric mucosa: a prospective pilot study (with video).
abstract: BACKGROUND
  Endocytoscopy (EC), as a novel ultrahigh magnification technology, enables in vivo histopathological diagnoses of the GI tract. EC is particularly exceptional when comparing dysplastic and neoplastic tissue with normal tissue. There are, however, no detailed data for minute or minimal changes in the gastric mucosa.
  
  
  OBJECTIVE
  To describe non-neoplastic EC patterns of the gastric mucosa correlated with histopathological findings and to determine any relationship with Helicobacter pylori (HP) infection.
  
  
  METHODS
  A pilot prospective study.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  Sixty-four participants undergoing upper endoscopy for various indications.
  
  
  METHODS
  Antral mucosal patterns on EC were divided into 4 categories: type 1 (normal), each papilla/pit has round smooth structure; type 2 (gastritis), extended, notched, and distorted structure with some necrotic tissue; type 3(atrophy), neighboring papilla/pit take on a lobulated appearance; type 4 (intestinal metaplasia [IM]), goblet cells are identified in a completely stained crypt. Target biopsy specimens were obtained from the region identified with these patterns, and multiple HP tests were performed.
  
  
  RESULTS
  HP positivity was 0%, 40.9%, 50.0%, and 58.3% in types 1, 2, 3, and 4, respectively. The sensitivity and specificity of types 2+3+4 for HP positivity were 100％ and 42.5%, respectively. The positive predictive values of type 1 for normal, type 2 for chronic gastritis, type 3 for atrophic gastritis, and type 4 for IM were 100%, 62.5%, 40.0%, and 100%, respectively. The sensitivity and specificity of types 3+4 for atrophic gastritis to IM were 87.0% and 95.1%, respectively.
  
  
  CONCLUSIONS
  Small, single-center, pilot study.
  
  
  CONCLUSIONS
  EC can differentiate gastric mucosal patterns of minimal, non-neoplastic change and appears to reliably exclude HP infection.
authors.affiliation: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yojohama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yojohama, Japan.
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Bu'Hussain
authors.initials: B
authors.lastname: Hayee
authors.affiliation: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yojohama, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yojohama, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Sato
authors.affiliation: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yojohama, Japan.
authors.forename: Chainarong
authors.initials: C
authors.lastname: Phalanusitthepha
authors.affiliation: Department of Gastroenterology, De La Salle University Medical Center, Dasmariñas City, Cavite, Philippines.
authors.forename: Esperanza Grace R
authors.initials: EG
authors.lastname: Santi
authors.affiliation: Kobayashi Internal Medicine Clinic, Kobe, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yojohama, Japan.
authors.forename: Shin-ei
authors.initials: SE
authors.lastname: Kudo
mesh_terms: D000368:Aged; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000473:pathology*; D015203:Reproducibility of Results