Evidence based review of the impact of image enhanced endoscopy in the diagnosis of gastric disorders

Ikram Hussain, Tiing Leong Ang, Ikram Hussain, Tiing Leong Ang

Abstract

Gastric cancer is the third most common cause of cancer-related death. Advanced stages of gastric cancers generally have grim prognosis. But, good prognosis can be achieved if such cancers are detected, diagnosed and resected at early stages. However, early gastric cancers and its precursors often produce only subtle mucosal changes and therefore quite commonly remain elusive at the conventional examination with white light endoscopy. Image-enhanced endoscopy makes mucosal lesions more conspicuous and can therefore potentially yield earlier and more accurate diagnoses. Recent years have seen growing work of research in support of various types of image enhanced endoscopy (IEE) techniques (e.g., dye-chromoendoscopy; magnification endoscopy; narrow-band imaging; flexible spectral imaging color enhancement; and I-SCAN) for a variety of gastric pathologies. In this review, we will examine the evidence for the utilization of various IEE techniques in the diagnosis of gastric disorders.

Keywords: Chromoendoscopy; Gastric cancer; Gastritis; Image enhanced endoscopy; Narrow band imaging.

Conflict of interest statement

Conflict-of-interest statement: Authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
High definition white light endoscopy view. A: A depressed lesion with mucosal discoloration due to early gastric cancer; B: High definition white light endoscopy view of early gastric cancer.
Figure 2
Figure 2
Mucosal irregularities and boundaries of a lesion. A: Gastric adenoma accentuated by indigo carmine; B: Early gastric cancer accentuated by indigo carmine.
Figure 3
Figure 3
Gastric intestinal metaplasia highlighted by methylene blue.
Figure 4
Figure 4
Gastric intestinal metaplasia highlighted by narrow band imaging using the EXERA III system with dual focus.
Figure 5
Figure 5
Best visualized with optical magnification. A: Magnifying narrow band image of gastric intestinal metaplasia showing, the light blue crest sign, surrounding central area of early gastric cancer; B: Magnifying narrow band image of early gastric cancer; C: Magnifying narrow band image of early gastric cancer.
Figure 6
Figure 6
Image of early gastric cancer visualized using narrow band imaging with digital magnification and dual focus imaging.
Figure 7
Figure 7
Performance characteristics. A: Image of gastric intestinal metaplasia visualized by blue laser imaging with optical magnification; B: Image of early gastric cancer visualized by blue laser imaging with optical magnification.

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