Usefulness of systematic chromoendoscopy with a double dye staining technique for the detection of dysplasia in patients with premalignant gastric lesions

IntroductionPremalignant gastric lesions have an increased risk to develop gastric cancer.ObjectiveTo evaluate the usefulness of systematic endoscopy that includes chromoendoscopy with a double dye staining technique for the detection of dysplasia in patients with premalignant gastric lesions.Patients and methodsThis longitudinal, prospective study was performed in patients with gastric atrophy, intestinal metaplasia or dysplasia who were referred for endoscopy less than 6 months after the initial diagnosis. The second endoscopy was performed in three phases: phase 1, exhaustive and systematic review of the mucosa with photographic documentation and biopsies of suspicious areas; phase 2, chromoendoscopy with a double dye staining technique using acetic acid 1.2% and indigo carmine 0.5%; phase 3, topographic mapping and random biopsies.ResultsA total of 50 patients were included. Nine (18%) had atrophic gastritis, 38 (76%) had intestinal metaplasia, and 3 (6%) had low-grade dysplasia. Systematic endoscopy with chromoendoscopy using a double dye staining technique detected more patients with dysplasia (9 vs. 3, p < .05), and a larger number of biopsies with the diagnosis of dysplasia were obtained. This occurred for visible (6 vs. 0, p < .05) and non-visible lesions (6 vs. 3, p = NS). In one patient, initial low-grade dysplasia was not detected again in the systematic endoscopy, giving a global endoscopic performance for the detection of lesions of 92%.ConclusionsPatients with premalignant gastric lesions have synchronous lesions with greater histological severity, which are detected when systematic endoscopy is conducted with indigo carmine dye added to acetic acid.

ResumenIntroducciónLas lesiones premalignas gástricas constituyen un factor de riesgo para desarrollar cáncer gástrico.ObjetivoEvaluar la utilidad de una endoscopia sistemática que incluye bicromoendoscopia para la detección de displasia en pacientes con lesiones premalignas gástricas.Pacientes y métodosEstudio longitudinal y prospectivo de pacientes consecutivos con diagnóstico de atrofia gástrica, metaplasia intestinal o displasia remitidos para nueva valoración por endoscopia antes de los 6 meses de la endoscopia inicial. La nueva endoscopia se realizó en 3 fases: revisión exhaustiva y sistemática de toda la mucosa con toma de fotos y biopsias de las lesiones sospechosas (fase 1), bicromoendoscopia con una mezcla de ácido acético 1,2% e índigo carmín 0,5% (fase 2) y mapeo topográfico con toma de biopsias aleatorias (fase 3).ResultadosCincuenta pacientes con diagnóstico de gastritis atrófica (n = 9, 18%), metaplasia intestinal (n = 38, 76%) y displasia de bajo grado (n = 3, 6%). La endoscopia sistemática con bicromoendoscopia identificó más pacientes con displasia (9 versus 3, p < 0,05) y se obtuvieron más biopsias con diagnóstico de displasia, tanto en lesiones visibles (6 vs. 0, p < 0,05) como no visibles (6 vs. 3, p = NS). En un paciente con displasia de bajo grado inicial, esta no volvió a detectarse en la endoscopia sistemática, siendo el rendimiento global de la endoscopia de seguimiento para detectar lesiones del 92%.ConclusionesLos pacientes con lesiones premalignas gástricas presentan lesiones sincrónicas de mayor severidad histológica que se ponen de manifiesto al realizar una endoscopia sistemática que incluye el uso de bicromoendoscopia.