What Have We Accomplished in Endoscopic Image Analysis for Atrophic Gastritis?

ABSTRACT

Identifying precancerous conditions such as atrophic gastritis and intestinal metaplasia (IM) has a crucial role in detecting high risk patients for gastric cancer. White light imaging (WLI) is a basic tool for diagnosing these premalignant conditions, however its low accuracy and high variability has been a serious problem in diagnosing these premalignant conditions. Several noble imaging technologies, such as magnifying endoscopy, narrow band imaging, autofluorescence imaging, and confocal laser endomicroscopy, provids us with chances of overcoming the limitations of conventional WLI. Autofluorescence images help us understand the extent of atrophic gastritis with vivid colors. Magnifying endoscopy with narrow band imaging shows microsurface structure and micrvascular architecture and is able to identify the degree of intestinal metaplasia by the presence of "light blue crest" sign. Confocal laser endomicroscopy produces reliable images of goblet cells that can replace biopsy. Usefulness of the new endoscopic imaging techniques for predicting gastric cancer development needs to be validated in clinical practice. Currently, it would be practical to apply magnifying endoscopy with narrow band imaging sequentially after white light endoscopy for identifying the presence of IM and atrophic gastritis.