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Recognition of goblet cells upon endocytoscopy indicates the presence of gastric intestinal metaplasia
Author(s) -
Chiu Philip Wai Yan,
Ng Enders Kwok Wai,
To Kai Fai,
Teoh Anthony Yuen Bun,
Lam Candice Chuen Hing,
Chan Francis Ka Leung,
Sung Joseph Jao Yiu,
Lau James Yun Wong
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12050
Subject(s) - medicine , dysplasia , intestinal metaplasia , gastroenterology , biopsy , pathology , goblet cell , gastritis , chronic gastritis , metaplasia , foveolar cell , gastric mucosa , stomach , epithelium
Background Gastric intestinal metaplasia ( IM ) is considered precancerous and is difficult to differentiate upon endoscopy. Endocytoscopy enables observation at a cellular level for focused biopsy. The present study examined the use of endocytoscopy for recognition of gastric IM . Patients and Methods Patients with a history of gastric IM were recruited. We first carried out narrow band imaging ( NBI ) endoscopy to look for suspicious areas of gastric IM . A prototype endocytoscope with a magnification of 450× was used to re‐examine these areas. Areas examined were biopsied for histological comparison. Presence of goblet cells was considered as representative of IM upon endocytoscopy. Results Twenty patients were recruited with NBI demonstrating 102 suspicious lesions of gastric IM . Mean age of patients was 53.9 ± 7.6 years. Upon histology, 72 biopsies were confirmed as gastric IM , 15 showed IM and low‐grade dysplasia, whereas 15were diagnosed as chronic gastritis. Endocytoscopy image quality was significantly better for areas of IM as compared to gastritis ( P < 0.05; OR 21.7 [95% CI 4.5–105.9]). The presence of goblet cells upon endocytoscopy achieved a diagnostic accuracy of 0.86 for gastric IM . Receiver operator characteristics curve achieved an area under curve of 0.8 with the presence of goblet cells under endocytoscopy as compared to 0.64 for NBI alone. Conclusions Presence of goblet cells upon endocytoscopy indicates a diagnosis of gastric IM . Image quality of endocytoscopy, however, is suboptimal. Further developments in endocytoscopy should focus on image quality and staining methods to enhance differentiation between IM , dysplasia and early gastric cancer.