Background and study aims: Gastric intestinal metaplasia (GIM) is associated with a risk for de- velopment of intestinal-type gastric cancer. This study aimed to compare the diagnostic yield of GIM from confocal laser endomicroscopy (CLE) and white light endoscopy (WLE). Patients and methods: In a prospective, double- blind, randomized study, patients were randomly assigned to receive either CLE with targeted biop- sies (group A) or WLE with a standard biopsy pro- tocol (group B). Results: A total of 168 patients were finally ana- lyzed (group A 85, group B 83). On a per-patient analysis, the diagnostic yields of GIM (including GIM with gastric intraepithelial neoplasia [GIN]) for groups A and B were 44.71% and 31.33%, respectively (P=0.074). On a per-biopsy analysis, CLE-targeted biopsygave a significantlyhigherdi- agnostic yield of GIM compared with WLE and standard biopsy, at 65.70% (113/172 biopsies) versus 15.73% (81/515 biopsies) (P<0.001). Moreover, the diagnostic yield of the operative link on gastric intestinal metaplasia (OLGIM) as- sessment stages III and IV was higher at 20.93% (36/172 biopsies) in group A versus 4.08% (21/ 515 biopsies) in group B (P<0.001). In addition, use of CLE-guided biopsy significantly decreased by 68% (P<0.001) the mean number of biopsies required per patient. Conclusions: CLE with targeted biopsies is super- ior to WLE with standard biopsies for the detec- tion and surveillance of GIM. The number of biop- sies needed to confirm GIM is about one third of that needed with WLE with standard biopsies.

第一署名医院：山东大学齐鲁医院