| BACKGROUND AND AIM:Since the year 1983 that helicobacter pylori in human gastric mucosa was first discovered, numerous studies with technology and experimental methods have constantly proved the close relationship between helicobacter pylori infection and a series of related diseases such as chronic gastritis, peptic ulcer and gastric mucosal intestinal metaplasia, atypical hyperplasia, intestinal-type gastric cancer and stomach mucosa associated lymphadenoma. Especially the sequence from helicobacter pylori associated active gastritis, atrophic gastritis, intestinal metaplasia, atypical hyperplasia and last to gastric carcinoma has been admitted by the domestic and foreign academic circles.Because the chronic gastritis-histological classification provided by the Sydney system needs several gastric mucosal samples, which easily causes bigger trauma and time and resources consumption, less application is used in clinical common practice. Thus, using the new endoscope to perform a real-time diagnosis becomes a hot spot in recent years. Special endoscopic technique, such as magnifying endoscopy and magnifying NBI endoscopy, has come to a primary good result in research of in-vivo diagnosis of H.pylori infection and its related chronic gastritis, which shows a certain value of clinical application.Confocal laser endomicroscopy (CLE), which's a newly endoscopic technique, can use diverse agent to help observe GI mucosa in vivo, with a magnification of 1000 times. However, CLE has come out within a short period so that no systmetic study has been done in the field that using fluorescein sodium aided CLE to diagnose H.pylori infection and its related chronic gastritis. In this study, we used confocal laser endomicroscopy to observe and analysis the characteristics of gastric mucosa infected by H.pylori, and then calculated the diagnostic accuracy of CLE in diagnosing H.pylori infection. Consequently we tried to classify the histilogical severity of H.pylori-associated gastritis under CLE observation.MATERIALS AND METHODS:Patients with upper gastrointestinal symptoms (Epigastric discomfort, sour regurgitation, satiety, abdominal distention and belching) or screened for gastric cancer were enrolled prospectively from June to November,2009, in Qilu Hospital, Shandong University. With the help of fluorescein sodium, we established the CLE diagnostic criteria for classification of histological severity of H. pylori-associated gastritis and H.pylori infection. Then we made a realtime diagnosis to the above two objectives. Diagnostic value of CLE for histological gastritis was investigated and compared with white light endoscopy. Targeted biopsies were performed from the CLE observed sites.RESULTS:We enrolled 118 consecutive patients for study of classification of chronic gastritis and 72 for H.pylori infection diagnose respectively. Score method and ROC analysis initially showed a sensitivity of 82.9% and a specificity of 90.9% of CLE for diagnosis of H. pylori infection. Another diagnostic criteria based on image judgement was established accordingly. The sensitivity and specificity were 94.6% and 97.4% of CLE for predicting gastric normal mucosa,98.5% and 94.6% for predicting histological active inflammation,92.9% and 95.2% for predicting glandular atrophy, and 98.6% and 100% for diagnosing intestinal metaplasia. Post-CLE image analysis showed goblet cells and absorptive cells were found the two most common parameters in CLE-diagnosed IM images (P<0.001). We could find more histological lesions of the stomach using CLE than white light endoscopy (WLE) (P<0.001). In the other study for H.pylori infection diagnosis, the total accuracy,sensitivity and specificity of CLE were 88.9%,91.2% and 86.8% respectively. Fluorescin leakage plus cell shedding had the best specificity (97.4%). Fluorescin leakage plus distortion of gastric pits had the best sensitivity (88.2%). Based on image judgement method, the Kappa value of interobsever agreement for CLE in diagnosing H.pylori infection was 0.72 and 0.87. The CLE images for H.pylori infection were highly related to those for active inflammation (P<0.001).CONCLUSION:1. CLE can reliably distinguish histological severity of H. pylori-associated gastritis in vivo. Mapping gastric atrophy and intestinal metaplasia by CLE may be performed efficiently with its good diagnostic accuracy. 2. CLE can accurately identify H.pylori infected gastric mucosa at a cell-level, which offers a reliable diagnostic tool for H.pylori in vivo.SIGNIFICANCE:With the advantage of the in vivo histological-level examination by CLE, the accurate identification of between inflammatory and non-inflammatory gastric mucosas can be achieved, which leads to a higher accuracy of gastritis-diagnose under endoscopy, and at the same time, the biopsy-inducing trauma and consumption of medical resources may be saved. Ultimately, our objective that using CLE to analogy the Sydney system for in vivo histological evaluation of the gastric entire Pathophysiological status successfully. |
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