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Cresyl violet as a new contrast agent in probe-based confocal laser endomicroscopy for in vivo diagnosis of gastric intestinal metaplasia

Yi-Ning Sun, Ming-Ming Zhang, Li-Xiang Li, Rui Ji, Xiao Wang, Peng Li, Yue-Yue Li, Meng-Qi Zheng, Guan-Qun Liu, Xiu-Li Zuo, Zhen Li, Yan-Qing Li
Journal of Gastroenterology and Hepatology 2019 September 13
31518444

BACKGROUND AND AIM: Cresyl violet (CV) is a topical dye that allows simultaneous chromoendoscopy and in vivo confocal laser endomicroscopy (CLE) in identification of neoplastic changes of the lower GI tract without intravenous injection of fluorescein, but as yet no investigation has reported its application in the diagnosis of gastric intestinal metaplasia (GIM). This study aims to assess the feasibility as well as diagnosis accuracy of topical CV for in vivo diagnosis of GIM by using probe-based confocal laser endomicroscopy (pCLE).

METHODS: In this prospective, open-label, feasibility study, 129 confocal videos from 22 patients with known GIM were analyzed and compared with corresponding histological images to establish the CV staining characteristics. In addition, 47 patients with known or suspected GIM were prospectively enrolled to evaluate the accuracy of this topical CV endomicroscopic imaging.

RESULTS: PCLE with topical CV enabled clear visualization of the goblet cells, absorptive cells and intestinal villi of GIM. The accuracy, sensitivity, specificity, positive and negative predictive value of pCLE diagnosis of GIM on a per-location analysis was 93.01%, 91.95%, 93.51%, 86.96%, and 96.11%, respectively. The ICC for inter-observer agreement and mean kappa value for intra-observer agreement for the diagnosis of GIM was 0.82 and 0.87, respectively.

CONCLUSIONS: Topical CV enables real-time chromoendoscopy in conjunction with pCLE examination of the stomach and warrants accurate diagnosis of GIM. It may be an acceptable and potentially alternative dye for confocal imaging in the future.

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