A comparative study of magnifying endoscopy with narrow-band image and endocytoscopy in the diagnosis of gastric neoplasm: A pilot study

Background/aims Endoscopic technologies have recently advanced to optimize the detection and diagnosis of gastric lesions. Endocytoscopy aids in the virtual realization of histology. Herein, we aimed to investigate gastric lesions using single-stain endocytoscopy and compare them using magnifying endoscopy with narrow-band imaging (ME-NBI) in terms of diagnostic yield in vivo. Methods and methods In the present prospective study, we registered 24 patients with gastric neoplasms and retrospectively reviewed their images. Three endoscopists reviewed the images of gastric neoplasms using white light, ME-NBI, and endocytoscopy. The diagnostic yield of endocytoscopy in early gastric cancer (EGC) was assessed using histopathology as the gold standard. Results Endocytoscopy was performed in 24 patients with gastric neoplasms. Of these, 15 patients had adenocarcinomas, while nine patients had low-grade dysplasia. The sensitivity, specificity, and accuracy of endocytoscopy for EGC detection were reported as 80.0% [95% confidence interval (CI), 51.9-95.7], 66.7% (95% CI, 58.4-91.9), and 75.0% (95% CI, 53.3-90.2) by endoscopist A; 80.0% (95% CI, 51.9-95.7), 44.4% (95% CI, 13.7-78.8), and 66.7% (95% CI, 44.7-84.4) by endoscopist B; and 93.3% (95% CI, 68.1-99.8), 55.6% (95% CI, 21.2-86.3), and 79.2% (95% CI, 57.9-92.8) by endoscopist C; these findings were not inferior to NBI. The inter-observer agreement, κ statistic = 0.67 (95% CI, 0.43-0.90) was favorable. Conclusion Endocytoscopy aid in the diagnosis of EGC because of its better sensitivity and accuracy compared to NBI or white-light imaging. However, further large-scale studies are required to confirm our findings.