Clin Endosc.  2021 Jul;54(4):477-487. 10.5946/ce.2021.160.

Application of Current Image-Enhanced Endoscopy in Gastric Diseases

• Lee W

• KMID: 2518849
• DOI: http://doi.org/10.5946/ce.2021.160

Abstract

Image-enhanced endoscopy (IEE) plays an integral role in endoscopic diagnosis and treatment. IEE enables an early and accurate detection of cancer and characterization of lesions prior to therapeutic decisions. Ideal IEE can serve as an optical or digital chromoscopic endoscopy, as well as an optical biopsy that predicts exact histopathology. Several IEE modalities have recently been developed and are used in the clinical field. The stomach is a challenging organ for imaging because of its complex secretion function and status of Helicobacter pylori infection. Therefore, understanding the current IEE modalities for their clinical applicability in an evidence-based approach is warranted. Along with technology refinements, the new paradigm will be available for the diagnosis of gastric cancer or other conditions in the stomach in the near future.

Keyword

Diagnosis; Endoscopy; Neoplasm; Stomach

Figure

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  Fig. 1. ME-NBI findings of stomach mucosa according to location and Heliciobacter pylori infection status. (A) Fundal mucosa without H. pylori infection. (B) Antral mucosa without H. pylori infection. (C) Fundal mucosa with H. pylori infection. ME-NBI, magnifying endoscopy with narrow band imaging.

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  Fig. 2. ME-NBI finding of intestinal metaplasia featuring light blue crest. (A) White light endoscopy. (B) ME-NBI. ME-NBI, magnifying endoscopy with narrow band imaging.

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  Fig. 3. ME-NBI finding in intestinal metaplasia featuring white opaque substance. (A) White light endoscopy. (B) ME-NBI. ME-NBI, magnifying endoscopy with narrow band imaging.

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  Fig. 4. ME-NBI findings on gastric adenocarcinoma featuring demarcation line and irregular microvascular or microsurface pattern. (A) Well differentiated type. (B) Signet ring cell type EGC. ME-NBI, magnifying endoscopy with narrow band imaging; EGC, early gastric cancer.

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  Fig. 5. CLE image of various gastric lesions. (A) Normal epithelium, featuring regularly arranged glands and epithelial cells with homogenous size and height. (B) Intestinal metaplasia with typical blackish goblet cells and prominent villi. (C) High-grade dysplasia featuring irregular glandular structure and increased epithelial cellularity. (D) Gastric cancer showing complete destruction of glandular structure, irregular shape and size of tumor cells, and disarrayed vasculature. CLE, confocal laser endomicroscopy.

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