Advanced endoscopic imaging in gastric neoplasia and preneoplasia

Gastric cancer is the third leading cause of cancer deaths worldwide. To decrease mortality, early detection and accurate diagnosis of gastric cancer through endoscopy is critical. In recent years, despite numerous advancements in endoscopic imaging, conventional white light endoscopy (WLE) remains the fundamental step for detection and characterisation of gastric lesions in clinical practice. However, conventional WLE may not accurately diagnose preneoplastic gastric lesions. Hence, the European Society of Gastrointestinal Endoscopy (ESGE) has recommended the use of image-enhanced endoscopy, including magnification chromoendoscopy and narrow band imaging to improve the diagnosis of gastric preneoplastic conditions. This review aims to highlight the available image-enhancing endoscopic modalities to aid diagnosis of gastric adenocarcinoma and preneoplastic gastric lesions, which include gastric intestinal metaplasia and dysplasia.

Confocal laser endomicroscopy (CLE) produces high-magnification histological-like images through measuring the gastric tissue reflectance as a low-power laser is used during endoscopy for illumination. CLE may be applied during real-time endoscopy through either using additional probes or dedicated endoscopes with integrated CLE systems.

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