Intestinal Metaplasia Clinical Trial
Official title:
Prospective Comparison Between Probe-based Confocal Laser Endomicroscopy, White-light Endoscopy and Virtual Chromoendoscopy for the Diagnosis of Gastric Pre-neoplastic and Neoplastic Lesions (pCLE-GCEP)
The investigators hypothesis that
1. clinical applicability and overall diagnostic sensitivity and specificity of pCLE for
diagnosing gastric preneoplastic and neoplastic lesions is acceptable
2. pCLE, as compared to white-light endoscopy (WLE), AFI and magnifying NBI has higher
sensitivity and specificity for the diagnosing gastric pre-neoplastic and neoplastic
lesions
Patients will be recruited from an ongoing study - Gastric Cancer Epidemiology, Clinical and
Genetic Programme Cohort Study (GCEP). GCEP is a prospective cohort study aiming to enroll
3,000 Singapore- Chinese subjects aged >50 years, and offers screening by endoscopy and
systematic follow-up for a minimum of 5 years. 20 patients will be randomized into two
groups. All of them will be examined using four different endoscopy imaging technologies by
one trained specialist. 10 patients will be in group A and another 10 patients will be in
group B. Group A: WLE followed by AFI followed by NBI followed by pCLE. Group B: WLE
followed by NBI followed by AFI followed by pCLE. The difference between two groups is the
sequence of two endoscopy imaging modes - AFI and NBI. Diagnosis made during NBI and AFI
must be made based on pre-defined criteria, and should not be influenced by the preceding
imaging modality. To control for the possible bias on the third imaging modality caused by
influence from the preceding imaging modality, patients are randomized to receive NBI before
AFI or AFI before NBI.
Endoscopic diagnosis will be made for each suspected lesion with every imaging modality. The
biopsy of lesions will be taken after pCLE examination is completed and sent for histology.
In the absence of suspicious lesions, the area of examination will be as follows (as stated
in main GCEP protocol):
- A1- lesser curvature of the antrum, within 2-3cm of the pylorus.
- A2- greater curvature of the antrum, within 2-3cm of the pylorus.
- IA- incisura angularis.
- B1- lesser curvature of the corpus, 4cm proximal to the angulus.
- B2- middle portion of the greater curvature of the corpus, 8cm from the cardia.
- Cardia (C) - within 1 cm below the OGJ (defined as the point where gastric folds
disappear).
The results will be compared with the gold standard diagnosis - histopathology diagnosis.
The sensitivity and specificity for each imaging tool will be calculated accordingly.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Diagnostic
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