Table 4

Endoscopic imaging modalities and performance characteristics for the diagnosis of gastric atrophy and intestinal metaplasia

Author (year)LocationPatients (n)Study designModalitySensitivity (%)Specificity (%)Condition
Dinis-Ribeiro et al 290 (2003)Portugal136ProspectiveME MB76.486.6GIM
Redéen et al 155 (2003)Sweden488ProspectiveWLE67–90 (absence of folds)
48–80 (body visible vessels)
14 (antrum visible vessels)
85–84 (absence of folds)
87–87 (body visible vessels)
91 (antrum visible vessels)
Uedo et al 166 (2006)Japan107ProspectiveNBI ME8993GIM
Anagnostopoulos et al
149 (2007)
UK95ProspectiveWLE ME90 (body type 4 pattern)96 (body type 4 pattern)AG
Bansal et al 147 (2008)USA47Pilot feasibilityNBI80 (ridge/villous pattern)100 (ridge/villous pattern)GIM
Guo et al 291 (2008)China53ProspectiveWLE vs CLE36.88 (WLE)
98.13 (CLE)
91.59 (WLE)
95.33 (CLE)
Tahara et al 292 (2009)Japan106ProspectiveME NBI (body)73.3 (type 3 NBI IM)
50 (type 3 NBI AG)
66.7 (WLE open type)
95.6 (type 3 NBI IM)
96.3 (type 3 NBI AG)
72 (WLE open type)
GIM and AG
Capelle et al 293 (2010)The Netherlands43ProspectiveNBI vs WLE71 (NBI)
51 (WLE)
58 (NBI)
67 (WLE)
Eshmuratov et al 170 (2010)Korea1330MC prospectiveWLE61.5 (antrum)−46.8 (body)57.7 (antrum)−76.4 (body)AG
Kawamura et al 294 (2011)Japan95 with active DU (n=24), diffuse-type
(n=24) and intestinal-type (n=47) EGC
ObservationalME NBITypes A-1 and A-2 (modified Yagi’s A-B classification system)
Severe AG-IM seen in the intestinal-type EGCs at the lesser curvature (accuracy figures not supplied)
AG and GIM
Rerknimitr et al 295 (2011)Thailand38 (I surveillance)
26 (II surveillance)
ProspectiveNBI78.8/91.3 (I/II surveillance)
3 criteria: LBC, VP and LLC
82.5/89.1 (I/II surveillance)
3 criteria: LBC, VP and LLC
Pimentel-Nunes et al 150 (2012)Europe85MC validationNBI89 (tubulovillous pattern)
48 (LBC)
90 (tubulovillous pattern)
96 (LBC)
Dutta et al 296 (2013)India200Randomised prospective crossoverNBI vs WLENBI was superior to WLE
(accuracy figures not supplied)
AG and GIM
An et al  167 (2012)Korea47ProspectiveME NBI100 (MTB)
72 (LBC)
66 (MTB)
96 (LBC)
Kanzaki et al 297 (2012)Japan50 with ECG and CAFGCross-sectional studyAFI+ME NBI
Body lesser curvature, groove type vs foveola type
Grade of AG-IM significantly higher in groove type compared with foveola type (accuracy figures not supplied)IM and AG
Savarino et al 298 (2013)Italy100ProspectiveNBI ME8096GIM
Fukuta et al 299 (2013)Japan163MC prospectiveWLE ICWLE: 94.6 (antrum)−86.1 (body)
IC: 78.4 (antrum)−86 (body)
WLE: 69.1 (antrum)−65.9 (body)
IC: 57.9 (antrum)−82.6 (body)
Lim et al 160 (2013)Korea1333ProspectiveWLEIM: 24 (antrum)−24.2 (body)
AG: 61.5 (antrum)−46.8 (body)
IM: 91.9 (antrum)−88 (body)
AG: 57.7 (antrum)−76.4 (body)
GIM and AG
Pittayanon et al 300 (2013)Thailand45ProspectiveME FICE+pCLEME FICE: 95.6
ME FICE+pCLE: 96.5
ME FICE: 79.2
ME FICE+pCLE: 90.5
Xirouchakis et al 301 (2013)Greece119Prospective openWLE - USP NBIAG: 86 (WLE-USP)−62 (NBI)
GIM: 80 (WLE-USP)−72 (NBI)
AG: 100 (WLE-USP)−97 (NBI)
GIM: 100 (WLE-USP)−93 (NBI)
AG and GIM
Nomura et al 302 (2014)Japan275MC prospectiveWLE±IC77 (body)−64 (antrum)79 (body)−54 (antrum)AG
Panteris et al 161 (2014)Greece234Prospective cross-sectionalWLE74.694GIM
Kikuste et al 163 (2014)Latvia126CohortFICE60 (diagnosis)−71 (OLGIM III–IV)87 (diagnosis)−87 (OLGIM III–IV)GIM
Ang et al 164 (2015)Asia-Pacific Region579MC prospective,
randomised, comparative
WLE NBI59.1 (WLE)−92.3 (NBI)98.6 (WLE)−94.3 (NBI)GIM
Pimentel-Nunes et al 162 (2016)Europe-USA238MC prospectiveWLE NBI53 (WLE)−87 (NBI)98 (WLE)−97 (NBI)GIM
Sha et al 303 (2017)China132Cohort comparative(AA-NBI) vs NBI vs WLE33.3 (WLE)
66.7 (NBI)
87.9 (AA-NBI)
28.8 (WLE)
68.2 (NBI)
68.2 (AA-NBI)
  • AA-NBI, acetic acid-narrow band imaging; AFI, auto-fluorescence imaging; AG, atrophic gastritis; CAFG, chronic atrophic fundic gastritis; CLE, confocal laser endomicroscopy; DU, duodenal ulcer; EGC, early gastric cancer; FICE, flexible spectral imaging colour enhancement; GIM, gastric intestinal metaplasia; IC, indigo carmine chromoendoscopy; IM, intestinal metaplasia; LBC, light blue crest; LLC, large long crest; MB, methylene blue; MC, multicentre; ME, magnification endoscopy; MTB, marginal turbid band; NBI, narrow band imaging; OLGIM, Operative Link on Gastric Intestinal Metaplasia assessment; pCLE, probe-based confocal laser endomicroscopy; USP, updated Sydney protocol; VP, villous pattern; WLE, white light endoscopy.