Narrow band imaging and serology in the assessment of premalignant gastric pathology

White, Jonathan R; Sami, Sarmed S; Reddiar, Dona; Mannath, Jayan; Ortiz Fern�ndez-Sordo, Jacobo; Beg, Sabina; Scott, Robert; Thiagarajan, Prarthana; Ahmad, Saqib; Parra-Blanco, Adolfo; Kasi, Madhavi; Telakis, Emmanouil; Sultan, Alyshah A; Davis, Jillian; Figgins, Adam; Kaye, Philip; Robinson, Karen; Atherton, John C; Ragunath, Krish

Abstract

Background: Patient outcomes in gastric adenocarcinoma are poor due to late diagnosis. Detecting and treating at the premalignant stage has the potential to improve this. Helicobacter pylori is also a strong risk factor for this disease.

Aims: Primary aims were to assess the diagnostic accuracy of magnified narrow band imaging (NBI-Z) endoscopy and serology in detecting normal mucosa, H. pylori gastritis and gastric atrophy. Secondary aims were to compare the diagnostic accuracies of two classification systems using both NBI-Z and white light endoscopy with magnification (WLE-Z) and evaluate the inter-observer agreement.

Methods: Patients were prospectively recruited. Images of gastric mucosa were stored with histology and serum for IgG H. pylori and Pepsinogen (PG) I/II ELISAs. Blinded expert endoscopists agreed on mucosal pattern. Mucosal images and serological markers were compared with histology. Kappa statistics determined inter-observer variability for randomly allocated images among four experts and four non-experts.

Results: 116 patients were prospectively recruited. Diagnostic accuracy of NBI-Z for determining normal gastric mucosa was 0.87(95%CI 0.82–0.92), H. pylori gastritis 0.65(95%CI 0.55–0.75) and gastric atrophy 0.88(95%CI 0.81–0.94). NBI-Z was superior to serology at detecting gastric atrophy: NBI-Z gastric atrophy 0.88(95%CI 0.81-0.94) vs PGI/II ratio 

Citation

White, J. R., Sami, S. S., Reddiar, D., Mannath, J., Ortiz Fernández-Sordo, J., Beg, S., Scott, R., Thiagarajan, P., Ahmad, S., Parra-Blanco, A., Kasi, M., Telakis, E., Sultan, A. A., Davis, J., Figgins, A., Kaye, P., Robinson, K., Atherton, J. C., & Ragunath, K. (2019). Narrow band imaging and serology in the assessment of premalignant gastric pathology. Scandinavian Journal of Gastroenterology, 53(12), 1611-1618. https://doi.org/10.1080/00365521.2018.1542455

• Journal Article Type: Article
• Acceptance Date: Oct 23, 2018
• Online Publication Date: Jan 2, 2019
• Publication Date: Jan 2, 2019
• Deposit Date: Jan 10, 2019
• Publicly Available Date: Jan 3, 2020
• Journal: Scandinavian Journal of Gastroenterology
• Print ISSN: 0036-5521
• Electronic ISSN: 1502-7708
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• Volume: 53
• Issue: 12
• Pages: 1611-1618
• DOI: https://doi.org/10.1080/00365521.2018.1542455
• Keywords: Endoscopy, narrow band imaging, white light endoscopy, serology, H. pylori gastritis, gastric atrophy, intestinal metaplasia
• Public URL: https://nottingham-repository.worktribe.com/output/1459417
• Publisher URL: https://www.tandfonline.com/doi/full/10.1080/00365521.2018.1542455
• Additional Information: This is an Accepted Manuscript of an article published by Taylor & Francis in Scandinavian Journal of Gastroenterology; on 2 Jan 2019, available online: http://www.tandfonline.com/10.1080/00365521.2018.1542455.; ; Corresponding author: Jonathan R White; Corresponding author email: [e-mail]
• Contract Date: Jan 10, 2019