Original Article
Copyright ©2010 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 7, 2010; 16(41): 5203-5210
Published online Nov 7, 2010. doi: 10.3748/wjg.v16.i41.5203
Classification of histological severity of Helicobacter pylori-associated gastritis by confocal laser endomicroscopy
Peng Wang, Rui Ji, Tao Yu, Xiu-Li Zuo, Cheng-Jun Zhou, Chang-Qing Li, Zhen Li, Yan-Qing Li
Peng Wang, Rui Ji, Tao Yu, Xiu-Li Zuo, Chang-Qing Li, Zhen Li, Yan-Qing Li, Department of Gastroenterology, Shandong University Qilu Hospital, Jinan 250012, Shandong Province, China
Peng Wang, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Cheng-Jun Zhou, Department of Pathology, Shandong University Qilu Hospital, Jinan 250012, Shandong Province, China
Author contributions: Wang P, Ji R and Li YQ designed the research; Wang P, Yu T, Zuo XL and Li YQ performed the research; Zhou CJ was responsible for the histological analysis; Wang P, Li CQ and Li Z analyzed the data; Wang P wrote the manuscript.
Supported by A Program from Clinical Projects of Ministry of Health of China (2007) and Taishan Scholar Program of Shandong Province
Correspondence to: Yan-Qing Li, Professor, Department of Gastroenterology, Shandong University Qilu Hospital, 107 Wenhuaxi Road, Jinan 250012, Shandong Province, China. liyanqing@sdu.edu.cn
Telephone: +86-531-82169236 Fax: +86-531-82169236
Received: June 18, 2010
Revised: August 2, 2010
Accepted: August 9, 2010
Published online: November 7, 2010
Abstract

AIM: To classify the histological severity of Helicobacter pylori (H. pylori) infection-associated gastritis by confocal laser endomicroscopy (CLE).

METHODS: Patients with upper gastrointestinal symptoms or individuals who were screened for gastric cancer were enrolled in this study. Histological severity of H. pylori infection-associated gastritis was graded according to the established CLE criteria. Diagnostic value of CLE for histological gastritis was investigated and compared with that of white light endoscopy (WLE). Targeted biopsies from the sites observed by CLE were performed.

RESULTS: A total of 118 consecutive patients with H. pylori infection-associated gastritis were enrolled in this study. Receiver operating characteristic curve analysis showed that the sensitivity and specificity of CLE were 82.9% and 90.9% for the diagnosis of H. pylori infection, 94.6% and 97.4% for predicting gastric normal mucosa, 98.5% and 94.6% for predicting histological active inflammation, 92.9% and 95.2% for predicting glandular atrophy, 98.6% and 100% for diagnosing intestinal metaplasia, respectively. Post-CLE image analysis showed that goblet cells and absorptive cells were the two most common parameters on the CLE-diagnosed intestinal metaplasia (IM) images (P < 0.001). More histological lesions of the stomach could be found by CLE than by WLE (P < 0.001).

CONCLUSION: CLE can accurately show the histological severity of H. pylori infection-associated gastritis. Mapping IM by CLE has a rather good diagnostic accuracy.

Keywords: Confocal laser endomicroscopy; Helicobacter pylori; Gastritis; Classification; Histology