Randomized Clinical Trial
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 3895-3907
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3895
Comparison of white-light endoscopy, optical-enhanced and acetic-acid magnifying endoscopy for detecting gastric intestinal metaplasia: A randomized trial
Ying-Hao Song, Li-Dong Xu, Meng-Xuan Xing, Kun-Kun Li, Xing-Guo Xiao, Yong Zhang, Lu Li, Yan-Jing Xiao, Yu-Lei Qu, Hui-Li Wu
Ying-Hao Song, Meng-Xuan Xing, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
Ying-Hao Song, Li-Dong Xu, Meng-Xuan Xing, Kun-Kun Li, Xing-Guo Xiao, Yong Zhang, Lu Li, Hui-Li Wu, Department of Gastroenterology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, Henan Province, China
Yan-Jing Xiao, Department of Pathology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, Henan Province, China
Yu-Lei Qu, Department of Gastroenterology, People's Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, Henan Province, China
Author contributions: Song YH, Xu LD, Qu YL and Xing MX were responsible for the study conception and design, data analysis and interpretation, and manuscript drafting; Li KK, Xiao XG, Zhang Y, Xiao YJ and Wu HL critically revised the article for important intellectual content; all the authors reviewed and approved the final version to be published. In addition, Ying-Hao Song wishes to thank Yu-Lei Qu for her patience, care and support over the past years. Will you marry me?
Supported by Key Project of Science and Technology of Henan, No. 202102310382.
Institutional review board statement: The research protocol was approved by the Ethics Committee of Zhengzhou Central Hospital Affiliated to Zhengzhou University, No. 202031.
Clinical trial registration statement: This study was registered at chictr.org.cn. The registration identification number is ChiCTR2000032072.
Informed consent statement: All participating patients provided written informed consent.
Conflict-of-interest statement: All authors declare no potential conflicting interests related to this paper.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Li Wu, MD, Chief Doctor, Department of Gastroenterology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, No. 16 North Tongbai Road, Zhongyuan District, Zhengzhou 450000, Henan Province, China. wuhuili660912@126.com
Received: November 6, 2020
Peer-review started: November 6, 2020
First decision: January 23, 2021
Revised: January 31, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: June 6, 2021
Processing time: 189 Days and 3.8 Hours
Abstract
BACKGROUND

Gastric intestinal metaplasia (GIM) is a precancerous lesion of the stomach, which severely affects human life and health. Currently, a variety of endoscopic techniques are used to screen/evaluate GIM. Traditional white-light endoscopy (WLE) and acetic-acid chromoendoscopy combined with magnifying endoscopy (ME-AAC) are the interventions of choice due to their diagnostic efficacy for GIM. Optical-enhanced magnifying endoscopy (ME-OE) is a new virtual chromoendoscopy technique to identify GIM, which combines bandwidth-limited light and image enhancement processing technology to enhance the detection of mucosal and vascular details. We hypothesized that ME-OE is superior to WLE and ME-AAC in the evaluation of GIM.

AIM

To directly compare the diagnostic value of WLE, ME-AAC, and ME-OE for detection of GIM.

METHODS

A total of 156 patients were subjected to consecutive upper gastrointestinal endoscopy examinations using WLE, ME-AAC, and ME-OE. Histopathological findings were utilized as the reference standard. Accuracy, sensitivity, specificity, and positive and negative predictive values of the three endoscopy methods in the diagnosis of GIM were evaluated. Moreover, the time to diagnosis with ME-AAC and ME-OE was analyzed. Two experts and two non-experts evaluated the GIM images diagnosed using ME-OE, and diagnostic accuracy and intra- and inter-observer agreement were analyzed.

RESULTS

GIM was detected in 68 of 156 patients (43.6%). The accuracy of ME-OE was highest (91.7%), followed by ME-AAC (86.5%), while that of WLE (51.9%) was lowest. Per-site analysis showed that the overall diagnostic accuracy of ME-OE was higher than that of ME-AAC (P = 0.011) and WLE (P < 0.001). The average diagnosis time was lower in ME-OE than in ME-AAC (64 ± 7 s vs 151 ± 30 s, P < 0.001). Finally, the inter-observer agreement was strong for both experts (k = 0.862) and non-experts (k = 0.800). The internal consistency was strong for experts (k = 0.713, k = 0.724) and moderate for non-experts (k = 0.667, k = 0.598).

CONCLUSION

For endoscopists, especially experienced endoscopists, ME-OE is an efficient, convenient, and time-saving endoscopic technique that should be used for the diagnosis of GIM.

Keywords: Magnifying endoscopy; Optical-enhanced; Acetic-acid; Gastric intestinal metaplasia

Core Tip: This study evaluated the diagnostic value of optical-enhanced magnifying endoscopy (ME-OE) for gastric intestinal metaplasia. By comparing ME-OE with existing magnifying endoscopy techniques, the study evaluated their diagnostic ability, operating time, and inter- and intra-observer agreements. Our study showed that ME-OE is an efficient, convenient, and time-saving endoscopic technique for endoscopists, especially experienced endoscopists. We recommend its wide clinical application in diagnosing gastric intestinal metaplasia.