title: Narrow-band imaging versus white light versus mapping biopsy for gastric intestinal metaplasia: a prospective blinded trial.
abstract: OBJECTIVE
  Gastric intestinal metaplasia (GIM) is a gastric cancer precursor. Narrow-band imaging (NBI) may improve detection of GIM. We compared detection of GIM with high-definition white-light (HD-WL) endoscopy, NBI, and mapping biopsies in a population with increased gastric cancer risk.
  
  
  METHODS
  Patients undergoing upper endoscopy had HD-WL examination by 1 endoscopist, followed by an NBI examination by a second endoscopist blinded to HD-WL findings. The location of abnormalities detected by HD-WL and NBI were recorded by a research coordinator, and targeted biopsies of abnormal areas were performed after NBI. Subsequently, 5 mapping biopsies were performed per patient. Biopsy specimens were read by a pathologist blinded to mode of acquisition. The primary outcome was the proportion of patients with GIM.
  
  
  RESULTS
  We enrolled 112 patients: 107 (96%) were Hispanic or Asian, and 34 (30%) had GIM. Higher proportions of patients with GIM were detected by NBI (22/34 [65%]) and mapping (26/34 [76%]) versus HD-WL (10/34 [29%]) (P < .005 for both comparisons). GIM was detected by NBI in only 6 patients and only by mapping biopsy in 10 patients; no patient had GIM detected solely by HD-WL. Higher proportions of sites with GIM also were detected with NBI (30/57 [53%]) and mapping biopsies (38/57 [67%]) than HD-WL (16/57 [28%]) (P < .005 for both comparisons). The median number of biopsies per patient with mapping biopsies (5) was significantly higher than with NBI (2) or HD-WL (1).
  
  
  CONCLUSIONS
  HD-WL endoscopy is insufficient for detection of GIM in patients at increased risk for gastric cancer. NBI-targeted biopsies plus mapping biopsies should be used. (Clinical trial registration number: NCT02197351.).
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Buxbaum
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hormozdi
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Christianne
authors.initials: C
authors.lastname: Lane
authors.affiliation: Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Diogo
authors.initials: D
authors.lastname: Dias-Silva
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Ara
authors.initials: A
authors.lastname: Sahakian
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Preeth
authors.initials: P
authors.lastname: Jayaram
authors.affiliation: Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pimentel-Nunes
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shue
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pepper
authors.affiliation: Division of Gastroenterology, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cho
authors.affiliation: Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D001706:Biopsy / Q000379:methods; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008027:Light; D008297:Male; D008679:Metaplasia / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D018570:Risk Assessment; D016037:Single-Blind Method; D013270:Stomach / Q000000981:diagnostic imaging / Q000473:pathology*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*