Title: Precancerous Risk Assessment of the Gastric Atrophy by Tri-modal Endoscopy
Authors: Fathi Ghamry Abdelrazek, Magdy Abd Elkareem Eldahshan, Shadia Hussein Mabrouk, Atef Aboelfotoh Ibrahim, Mohamed Salah Ali Hussein, Mohamed Samy EL Shahawy, Zakaria Mohamed Zakaria, Ahmed Ibrahim Gawish
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.148
Abstract
Background / Aims: Gastritis staging and detection of pre-neoplastic gastric mucosal changes based on the histology of biopsy specimen imposes a considerable burden on endoscopist and pathologist. Therefore, we attempted to evaluate whether gastritis staging system based on the using of conventional high-resolution white light endoscopy(WLE), Auto fluorescence imaging(AFI),and narrow band imaging(NBI) is equivalent to that determined by histopathology.
Methods: This study included 63 egyptian patients who were diagnosed with chronic gastritis. The lesser curvature of the antrum (2 cm from the pyloric ring) and the lesser curvature of the lower body (4 cm from the angle) were examined in consecutive order first by high resolution WLE followed by AFI and finally by NBI. Two endoscopic biopsies were taken from gastric antrum and lower gastric body for histopathological assessment of H. Pylori infestation, gastric atrophy and intestinal metaplasia (IM).The lower gastric body atrophy was graded according to OLIGA scoring system (Operative Link for Gastritis Assessment) . Additionally, the presence or absence of IM was examined in both lower gastric body and antrum.
Results: By means of WLE and AFI, the patients were found to have no, mild, moderate and severe gastric atrophy in 8(16%), 18(36%), 8(16%), and 16(32%) respectively. Furthermore, Gastric atrophy was detected in all patients by NBI with mild, moderate and severe atrophy in 15(30%), 24(48%) and 11(22%) respectively. as a result of histopathological assessment, 12(24%), 34(68%), and 4(8%) had scores 1, 2 and 3 by OLIGA scoring systems respectively. in view of scoring system of gastric atrophy and intestinal metaplasia, New staging system for gastritis risk assessment was correctly identified Furthermore, Gastric cancer risk stages were recognized and the degree of correspondence on the basis of NBI and combined WLE , AFI on one hand and histopathology on the other hand were 80% and 68%.
Conclusion: This study demonstrates that staging of premalignant gastric lesions with conventional NBI has better correspondence with histopathology compared with WLE and AFI and can be used for screening early malignancies of the stomach .
Keywords: Narrow-band imaging, Auto-fluorescence imaging, Intestinal metaplasia, white -light endoscopy, Gastric atrophy.
Mohamed Samy EL Shahawy
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