Clinical control role of magnifying endoscopy with narrow-band imaging plus forceps biopsy for gastric low-grade intraepithelial neoplasia

Objective To evaluate the clinical control role of magnifying endoscopy with narrow-band imaging plus forceps biopsy for gastric low-grade intraepithelial neoplasia detected by normal endoscopic biopsy. Methods This retrospective study enrolled 142 patients between January 2012 to December 2017, who were diagnosed as gastric LGIN by forceps biopsy in the first endoscopy examination and followed up by endoscopic surveillance. All the cases received endoscopic submucosal dissection or operation. One hundred and forty-two patients were divided into three groups according to different methods used to reexamine, including conventional white-light imaging (C-WLI) plus biopsy group, magnifying endoscopy with narrow-band imaging (ME-NBI) group and magnifying endoscopy with narrow-band imaging (ME-NBI) plus biopsy group. The consistent rate between the endoscopic-reexamined diagnosis and the pathologic diagnosis after ESD or operation in the three groups were compared. According to the pathologic diagnosis after ESD or operation, they were divided into two groups:the non-cancer group and the cancer group, the clinic and endoscopic characteristics between the non-cancer group and the cancer group were analyzed. Results The accuracy, sensitivity, specificity, NPV and PPV were significantly higher in ME-NBI group than those in C-WLI plus biopsy group and ME-NBI plus biopsy group: 94.59% vs. 86.76% and 81.08%, 85.71% vs. 62.50% and 75.00%, 100.00% vs. 100.00% and 84.78%, 100.00% vs. 100.00% and 75.00%, 92.00% vs. 83.02% and 86.27%. As for the clinic and endoscopic characteristics, there was no statistically significant difference between the non-cancer group and the cancer group with age of patients, gender of patients, location of lesions, gastric mucosal atrophy, intestinal metaplasia and H.pylori infections (P>0.05). There was statistically significant difference with the size>1 cm, redness, nodularity and depression between the two groups (P<0.05). Conclusions Using the method of ME-NBI plus biopsy, actual high-grade intraepithelial neoplasia or early carcinoma can be differentiated from low-grade intraepithelial neoplasia so that treatment can be performed without delay.For the lesions of the size>1 cm, redness, nodularity and depression, they need to be reexamized as quickly as possible by the method of ME-NBI plus biopsy. Key words: Gastroscopes; Diagnostic imaging; Low-grade intraepithelial neoplasia; Endoscopic submucosal dissection