Open Access Research article

Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia

Jin Kwang An1, Geun Am Song1, Gwang Ha Kim1*, Do Youn Park2, Na Ri Shin2, Bong Eun Lee1, Hyun Young Woo1, Dong Yup Ryu1, Dong Uk Kim1 and Jeong Heo1

Author affiliations

1 Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea

2 Department of Pathology, Pusan National University School of Medicine, Busan, Korea

For all author emails, please log on.

Citation and License

BMC Gastroenterology 2012, 12:169  doi:10.1186/1471-230X-12-169

Published: 27 November 2012

Abstract

Background

Gastric intestinal metaplasia (IM) usually appears in flat mucosa and shows few morphologic changes, making diagnosis using conventional endoscopy unreliable. Magnifying narrow-band imaging (NBI) endoscopy enables evaluation of detailed morphological features that correspond with the underlying histology. The aim of this study was to investigate and clarify the diagnostic efficacy of magnifying NBI endoscopic findings for the prediction and diagnosis of IM.

Methods

Forty-seven patients were prospectively enrolled, and magnifying NBI examinations were performed in the lesser curvature of the midbody and the greater curvature of the upper body. The marginal turbid band (MTB) was defined as an enclosing white turbid band on the epithelial surface/gyri; light blue crest (LBC), as a fine, blue-white line on the crest of the epithelial surface/gyri. Immediately after observation under magnifying endoscopy, biopsy specimens were obtained from the evaluated areas.

Results

The degree of IM significantly increased with increasing MTB/LBC positivity (MTB-/LBC-, 0.00 ± 0.00; MTB+/LBC-, 0.44 ± 0.51; MTB+/LBC+, 0.94 ± 0.24; p < 0.001). Moderate-to-severe IM was more common in MTB+/LBC+ areas than in MTB+/LBC- areas (p < 0.001). For the diagnosis of IM, MTB had a sensitivity, specificity, and accuracy of 100%, 66.0%, and 81.7%, respectively, and the corresponding values for LBC were 72.1%, 96.0%, and 84.9%.

Conclusion

MTB and LBC observed in the gastric mucosa with magnifying NBI endoscopy are highly accurate indicators of the presence of IM. MTB likely represents a sign of early gastric IM, while LBC appears with progression to severe IM.

Keywords:
Stomach; Magnifying endoscopy; Intestinal metaplasia