Endoscopic validation of virtual chromoendoscopy (FICE) in the detection of gastric preneoplastic lesions vs. histopathology

Abstract

Introduction: Gastric preneoplastic lesions are associated with an increased risk of progression to gastric cancer. Conventional upper gastrointestinal endoscopy and histopathology are the gold standard for the diagnosis of these lesions. However, virtual chromoendoscopy (FICE: Fuji Intelligent Chromo Endoscopy), and; Endoscopic Magnification (EM) allow a better characterization of these lesions. The objective is to evaluate the conventional endoscopic visual concordance and virtual chromoendoscopy (FICE) with EM using the Kimura-Takemoto classification system and the MODIFIED SIDNEY histopathological system in subjects attending the Gastroenterology outpatient clinic of Hospital Eugenio Espejo. Methodology: Analytical epidemiological study, cross-sectional period, in which 140 participants were included. Results: Presence of gastric preneoplastic lesions was found in 67% detected by FICE with EM; while, by histopathology, 54% of lesions were detected. The endoscopic diagnosis by FICE had a sensitivity of 97.53%, specificity of 67.79% PPV of 80.61% and NPV of 95.23%. In a subsample of 90 subjects with preneoplastic lesions considered to be of lower risk, a sensitivity of 98.55%, specificity of 5%, PPV of 78.16% and NPV of 50% were observed. For dysplasia, a sensitivity of 80%, specificity of 100%, PPV of 100% and NPV of 97.56% were observed. In the analysis of the relationship between the male gender and the presence of preneoplastic lesions, a sensitivity of 92.30%, specificity of 46.15%, PPV of 63.15% and NPV of 85.71% were observed. Four cases of gastric cancer were detected by chromoendoscopy with 100% sensitivity and specificity that were confirmed by histopathology. Finally, 60% of the subjects present Helicobacter Pylori infection, of which the majority correspond to subjects with intestinal metaplasia and multifocal atrophy. Conclusion: The detection of preneoplastic gastric lesions using virtual chromoendoscopy type FICE and ME has a high sensitivity, therefore, it is recommended as a screening for the detection of preneoplastic gastric lesions in Ecuador.