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World J Gastroenterol. 2011 Mar 14;17(10):1336-42. doi: 10.3748/wjg.v17.i10.1336.

Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia.

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Department of Medicine, Chulalongkorn University, Bangkok 10310, Thailand.



To evaluate the efficacy of non-sequential narrow band imaging (NBI) for a better recognition of gastric intestinal metaplasia (GIM).


Previously diagnosed GIM patients underwent targeted biopsy from areas with and without GIM, as indicated by NBI, twice at an interval of 1 year. The authors compared the endoscopic criteria such as light blue crest (LBC), villous pattern (VP), and large long crest (LLC) with standard histology. The results from two surveillance endoscopies were compared with histology results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of positive test (LR+). The number of early gastric cancer cases detected was also reported.


NBI targeted biopsy was performed in 38 and 26 patients during the first and second surveillance endoscopies, respectively. There were 2 early gastric cancers detected in the first endoscopy. No cancer was detected from the second study. Surgical and endoscopic resections were successfully performed in each patient. Sensitivity, specificity, PPV, NPV, and LR+ of all 3 endoscopic criteria during the first/second surveillance were 78.8%/91.3%, 82.5%/89.1%, 72.8%/77.8%, 86.8%/96.1, and 4.51/8.4, respectively. LBC provided the highest LR+ over VP and LLC.


Non-sequential NBI is useful for GIM targeted biopsy. LBC provides the most sensitive reading. However, the optimal duration between two surveillance requires further study.


Gastric cancer; Gastric intestinal metaplasia; Non-sequential narrowband imaging

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