Best Practice & Research Clinical Gastroenterology
11Advanced endoscopic imaging for gastric cancer assessment: New insights with new optics?
Introduction
Gastric cancer (GC) is the third most common cause of cancer deaths worldwide [1]. Although advanced GC is associated with poor prognosis and high mortality rates, early detection and treatment can result in 5-year survival rates as high as 96% [2]. Helicobacter pylori (H. pylori) is considered the most important risk factor for GC, by promoting a multi-step process of chronic gastritis, atrophy, intestinal metaplasia (IM), dysplasia and, finally, intestinal-type adenocarcinoma [3].
Secondary prevention through diagnosis of premalignant lesions and early gastric cancer (EGC) and screening or follow-up of individuals at high risk, are probably the most immediate strategies for improving survival ∗[4], [5]. Endoscopy examination is therefore of paramount importance. Identification of EGC, however, is difficult because of the lack of gross endoscopic signs. Moreover, despite the ability of experienced endoscopists to detect abnormalities, accurate differentiation among these gastric lesions for therapeutic decision making (ie, endoscopic resection, surgery, or follow-up) is extremely difficult [6], [7], and it is not surprising that ancillary techniques such as chromoendoscopy have been used for an accurate diagnosis of precancerous lesions and/or invasiveness of cancerous lesions [8], ∗[9], [10], but it lengthens the time of the endoscopic procedure and is not very popular among endoscopists, particularly in Western countries.
Over the past decade, the advent of new advanced endoscopic imaging technology, namely high-resolution with narrow band imaging (NBI) and flexible spectral imaging color enhancement (FICE), with or without magnification has revolutionized the endoscopic examination of the stomach. Diverse descriptions of these modalities have been published, reporting them to be useful for the accurate diagnosis and characterization of gastric precancerous conditions and lesions [11], [12], [13], [14], [15], ∗[16], [17].
Recently, the development of confocal laser endomicroscopy (CLE), endocytoscopy and molecular endoscopy enabled microscopic tissue analysis of the gastric mucosa at real time during endoscopy. This not only aims at imitation of histopathology, but is used to target few biopsies to regions of interest by multiple optical biopsies, and to guide endoscopic interventions [18].
In this review, we will assess GC detection and characterization in individuals at high-risk (i.e., advance stages of gastric atrophy/IM) and in those harbouring neoplastic lesions, and address the usefulness of advanced imaging techniques on that task.
Section snippets
Individuals at high-risk
Whether screening, especially that of the mass population, should be done remains controversial because the incidence of GC varies substantially among countries and within the same ethnic group. Even in a very high risk area, there is only some evidence that mass screening reduces mortality from GC [19]. Therefore, identification of high-risk populations to undergo screening is fundamental for the early detection of GC in countries with medium to low incidence [20].
Patients who have established
NBI (Narrow-band Imaging)
NBI is a novel optical image-enhancement technology that improves visualization of the vascular architecture and the surface microstructure of the superficial mucosa enabling tissue characterization, differentiation and diagnosis without the use of dyes [42]. Presently, two different systems are available: the 200 series using a rotating red-green-blue (RGB) filter and the 100 series, which uses a charge-coupled device (CCD) chip. Each system has its advantages, with the former producing
Algorithm – a stepwise approach to gastroscopy
In all every day gastroscopy observe in detail all gastric mucosa (Fig. 1).
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standardize observation is suggested by most training programmes and/or position statements (e.g. ESGE);
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special attention should be given to sufficient insufflation, cleaning of mucosa and retroflexion;
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interpret each gastroscopy as an opportunity to detect a GC;
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high-resolution scopes provide better inspection compared with conventional scopes.
First, detect early neoplastic lesions.
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A stepwise observation should be
Conflict of interest
Mário Dinis-Ribeiro has a research and training grant from Olympus Europe.
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One piece biopsy for both rapid urease test and cultivation of Helicobacter pylori
2019, Journal of Microbiological MethodsCitation Excerpt :At present, there are both invasive (e.g. culture, a rapid urease test and histology) and non-invasive (e.g. urea breath test, serology and a stool antigen test) diagnostic assays for detection of H. pylori that they should be reliable, simple and quick to perform. However, high-resolution endoscopic technologies enable increased diagnostic accuracy for the detection of H. pylori infections (Serrano, Kikuste, and Dinis-Ribeiro, 2014). The study was designed for the detection of the microorganism from one biopsy specimen through the performance of a rapid urease test and culture to inflict minimum harm to gastric tissue of the patients especially in whom two or more attempts at eradication was unsuccessful.
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