Diagnosis Of Atrophy Gastritis And Gastric Intestinal Metaplasia With Confocal Laser Endomicroscopy In Vivo

Background: Gastrointestinal neoplasm ranks at front across the world. If diagnosis ofneoplasm happens at the early stage,the prognosis will improve. Gastric intestinalmetaplasia(GIM)is a risk factor that leads to the development of intestinal-type gastric cancer.The pathogenesis of GIM is probably a combination of factors related to both Helicbacterpylori and genetic aspects of the host; it is also likely that environmental factors are involvedin this precancerous condition. The diagnosis of GIM is based on histopathologicalexamination of endoscopic biopsy speciments.Several previous studies have been carried out to develop up-to-date endoscopic criteriafor diagnosing GIM. Conventional endoscopic identification of GIM has a high rate ofintraobserver variability and correlates poorly with the histological findings.Chromoendoscopy with magnifying endoscopes and narrow-band-imaging(NBI) techniquesare limited to the recognition of morphologic changes(mucosal and vascular patterns); biopsyand subsequent histological evaluation are still needed for the final diagnosis of GIM. Noneof them can distinguish the structure of individual cells. However, biopsy requires complexand time-consuming procedures. This may limit the immediate diagnosis, resulting in theneed for repeat endoscopic procedures.Recently ,a CLE has been developed with a confocal microscope integrated into thedistal tip of a convetional video endoscope. The new device can provide real time, highmagnification, cross-sectional images of the gastrointestinal epithelium during routineendoscopy. The advantage of the microendoscope is its approximately 1000-fold magnification, which readily permits single cells in the gastrointestinal tract to be resolved.CLE provides a histological diagnosis during endoscopy without biopsy, and thus thistechnique has been termed"optical biopsy".Objective: We aim to assess the usefulness of confocal laser endomicroscopy (CLE) indiagnosing atrophy gastritis and gastric intestinal metaplasia.Methods: 46 patients who were diagnosed atrophy gastritis by conventional endoscopeunderwent CLE. The agreement of diagonosis of atrophy gastritis and GIM between CLE andhistopathology was assessed.Results: in the prospective study 6993 CLE images were obtained from 249 sites. Thekappa value for the correlation with histological findings of atrophy gastritis was 0.4186forCLE. The sensitivity and specificity of CLE in diagnosis of atrophy gastritis were 88.47% and67.50%. The kappa value for the correlation with histological findings of GIM was 0.578 forCLE. The sensitivity and specificity of CLE in diagnosis of GIM were 85.98% and 70.59%.Conclusion: CLE is a useful and potentially important method for the diagnosis ofatrophy gastritis and GIM in vivo.