Diagnostic value of confocal laser endomicroscopy in predicting the grading of gastric intestinal metaplasia / 中华消化杂志

ABSTRACT

Objective To evaluate the efficacy of confocal laser endomicroscopy(CLE)for the assessment of the grading of gastric intestinal metaplasia(GIM)in vivo.Methods Patients with known GIM underwent CLE(Pentax EC-3870K).The presence of GIM was indentified immediately by the endoscopist during the procedure.The updated Sydney Classifycation System as reference,GIM was subdivided as mild,moderate and severe according to the area of intestinal metaplasia glands and the number of goblet cells.The histological evaluation remained the gold standard for the final diagnosis of GIM.The presence of the dysplasia and the expression of the Ki67 were examined.Results A total of 151 GIM positive areas were found in 58 patients with mild in 92,moderate in 34.and severe in 25 by CLE. One hundred and forty-six GIM areas were examined histopathologically with positive rate of 96.7%(mild in 82,moderate in 36 and severe in 28).The sensitivity and specificity of CLE were 90.2%and 73.9%in diagnosis of mild GIM,69.4 oA and 92.2%in moderate GIM,71.4% and 95.9%in severe GIM.The kappa coefficient of CLE criteria and the histopathological grading for mild,moderate and severe GIM were 0.65,0.63 and 0.70,respectively.The more severe the GIM,the higher the ratio of incomplete GIM,the ratio of dysplasia and the stronger expression of Ki67.Conclusions CLE may offer an instant and reliable diagnosis for GIM with high accuracy.It is helpful in grading of GIM.