The accuracy of confocal laser endomicroscopy, narrow band imaging, and chromoendoscopy for the detection of atrophic gastritis.

Objective: The aim of this study was to compare chromoendoscopy (CE), narrow band imaging (NBI), and confocal laser endomicroscopy (CLE) in diagnosing atrophic gastritis. Backgrounds: Atrophic gastritis, especially metaplastic atrophy, has been shown to be a risk factor for gastric cancer. Some advanced endoscopic techniques have been used to diagnose atrophic gastritis. However, it is still difficult to diagnose atrophy with a high degree of accuracy. Study: In total, 253 gastric sites from 87 consecutive patients were examined by NBI, CE, and CLE, and in turn endoscopic diagnoses were made. Histologic diagnoses of biopsies taken from the observed sites served as gold standards. Comparisons were made of the sensitivity, specificity, and accuracy between each endoscopic technique for obtaining a diagnosis atrophic gastritis. Results: NBI was found to be equivalent to CE in classifying gastric pits (kappa= 0.904). The CLE had a higher sensitivity (P= 0.035), specificity (P= 0.049), and accuracy (P= 0.002) than CE for diagnosing atrophic gastritis. The sensitivity and specificity of CLE for diagnosing nonmetaplastic atrophy were 86.76% and 91.89%, respectively, and for metaplastic atrophy were 91.94% and 96.86%, respectively. Interobserver and intraobserver agreements of CLE for predicting histopathologic gastritis were both high (0.938 and 0.895, respectively). Conclusions: CLE is reliable for real-time assessment of atrophic gastritis and is also able to differentiate metaplastic from nonmetaplastic atrophy.