Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial

BackgroundA novel narrow band imaging (NBI) system is able to visualize the mucosal and vascular network in the GI tract.ObjectiveThe aim of the current study was to test the feasibility of NBI to predict gastric histologic diagnosis.DesignA pilot feasibility study.SettingVeterans Affairs Medical Center.PatientsForty-seven patients undergoing upper endoscopy for various indications were prospectively enrolled.MethodsThe gastric body and antrum were systematically examined by NBI before targeted biopsies. Images were graded according to the mucosal (ridge/villous and circular) and vascular patterns and correlated with histologic findings in a blinded manner.Main Outcome MeasurementsFinal histologic diagnosis based on updated Sydney classification system.ResultsOverall, 25 patients (53.1%) had a normal biopsy specimen, 13 (27.6%) had non–Helicobacter pylori gastritis, 4 (8.5%) had H pylori gastritis, and 5 (10.6%) had intestinal metaplasia. The sensitivity, specificity, and positive predictive value of a regular mucosal and vascular pattern for the diagnosis of normal mucosa/mild gastritis were 89%, 78%, and 94%, respectively. The sensitivity and specificity of an irregular pattern with decreased density of vessels for the diagnosis of H pylori were 75% and 88%, and that of the ridge/villous pattern for the diagnosis of intestinal metaplasia were 80% and 100%, respectively.LimitationThe small number of patients with H pylori and intestinal metaplasia was the main limitation.ConclusionsThis is the first U.S. study of NBI for gastric lesions. NBI may help predict in vivo histologic diagnosis of gastric pathologic conditions with a good degree of accuracy. Future larger studies are needed.