Novel endoscopic findings as visualized by non-magnification endoscopy with linked color imaging are indicative of gastric intestinal metaplasia

Min Min, Teng-Hui Dong, Yan Liu, Yi-Liang Bi, Cui-Yun Ma, Min Min, Teng-Hui Dong, Yan Liu, Yi-Liang Bi, Cui-Yun Ma

Abstract

Background: Gastric intestinal metaplasia (GIM) is generally considered to be the main mucosal background for the development of gastric adenocarcinomas. Using linked color imaging (LCI), we noticed that the color pattern in areas of GIM was purple mixed with white on the epithelium with signs of mist that were detected by the non-magnifying LCI observation. We have termed this endoscopic finding "Purple in Mist" (PIM). The aim of this study was to investigate whether PIM could be a useful optical sign for predicting GIM.

Methods: We prospectively evaluated consecutive patients undergoing endoscopy for various indications. The endoscopist used the LCI system to carefully observe the gastric antrum, body and angulus. When a PIM was identified in the surface layer, targeted biopsies were subsequently taken from this part. If the suspected area had no PIM on the surface, targeted biopsies were also taken.

Results: Sixty-three consecutive patients were included in this study. The prevalence of intestinal metaplasia (IM) was 29/63 (46%). In PIM-positive patients, the prevalence of IM was 23/26 (89%). Of these patients, 146 biopsy specimens were included in this study. For the diagnosis of IM, compared to histological assessment, the LCI finding had an accuracy of 91.1% (95%CI: 86.5%-95.7%), a sensitivity of 89.8% (95%CI: 81.3%-98.3%), a specificity of 91.8% (95%CI: 86.3%-97.2%), a positive predictive value of 84.6% (95%CI: 74.8%-94.4%), and a negative predictive value of 94.7% (95%CI: 90.1%-99.2%).

Conclusions: A positive PIM finding in a suspicious lesion on LCI would complement LCI diagnosis of possible IM because of the positive predictive value of PIM. PIM could be a novel endoscopic marker for IM.

Trial registration: ClinicalTrials.gov, No. NCT03092414; https://ichgcp.net/clinical-trials-registry/NCT03092414?id=NCT03092414&rank=1.

Figures

Figure 1
Figure 1
Typical endoscopic LCI images for edible dye (yellow, purple, and red) spray at different distances. A: Straight red; B: Tangential red; C: Yellow; D: Purple; LCI: Linked color imaging.
Figure 2
Figure 2
Appearance of intestinal metaplasia in the gastric lesser curvature under WL and LCI mode. Endoscopic image in WL shows ash-colored nodular changes (A). Endoscopic image in LCI shows PIM (blue arrows) in lesser curvature (B). Magnifying endoscopy with LCI showing PIM (C) (blue arrows) (Original magnification × 80). Histopathological appearance with hematoxylin and eosin (H&E, original magnification ×20) staining showing intestinal metaplasia (D). LCI: linked color imaging; PIM: “Purple in Mist”; WL: White light.
Figure 3
Figure 3
(A) Magnifying endoscopy with blue-laser imaging (M-BLI) of IM exhibit as bluish-whitish areas (Original magnification × 60). (B) When switched to the magnifying LCI (M-LCI), PIM was pointed with blue arrows (Original magnification × 60). (C) M-BLI showing LBCs at the edge of the marginal crypt epithelium (yellow arrows) (Original magnification × 80). (D) When switched to the M-LCI, LBC turns to bright-white lines visible on the epithelial surface (yellow arrows) (Original magnification × 80). IM: Intestinal metaplasia; LBC: Light-blue crests; LCI: Linked color imaging; PIM: “Purple in Mist”.
Figure 4
Figure 4
(A) Magnifying endoscopy with LCI showing submucosal vessels appear purple (white arrows). (B) When switched to the magnifying BLI, submucosal vessels appear deep green (white arrows). BLI: Blue-laser imaging; LCI: Linked color imaging.

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Source: PubMed

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