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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


Jonathan R White

Sarmed S Sami

Dona Reddiar

Jayan Mannath

Jacobo Ortiz Fern�ndez-Sordo

Sabina Beg

Robert Scott

Prarthana Thiagarajan

Saqib Ahmad

Adolfo Parra-Blanco

Madhavi Kasi

Emmanouil Telakis

Alyshah A Sultan

Jillian Davis

Adam Figgins

Philip Kaye

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Professor in Gastrointestinal Infection and Immunity

John C Atherton

Krish Ragunath


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 


White, J. R., Sami, S. S., Reddiar, D., Mannath, J., Ortiz Fernández-Sordo, J., Beg, S., …Ragunath, K. (2019). Narrow band imaging and serology in the assessment of premalignant gastric pathology. Scandinavian Journal of Gastroenterology, 53(12), 1611-1618.

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 & Francis Open
Peer Reviewed Peer Reviewed
Volume 53
Issue 12
Pages 1611-1618
Keywords Endoscopy, narrow band imaging, white light endoscopy, serology, H. pylori gastritis, gastric atrophy, intestinal metaplasia
Public URL
Publisher URL
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:

Corresponding author: Jonathan R White
Corresponding author email:


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