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

Table 3 Summary of image-enhanced endoscopy in stomach

Technique	Use	Evidence	Remarks
High-definition WLE	Standard of care for initial examination of gastric mucosa	Not available
WLE with magnification	Helpful in describing normal mucosal patterns in corpus and antrum. Appears useful in predicting real-time diagnosis of H. pylori infection. Better than WLE for characterization of EGCs	Multiple prospective comparative studies for identifying H. pylori infection and for characterization of EGCs	A variety of classifications in describing the normal and abnormal mucosal pattern makes interpretation difficult for widespread use
Dye-based chromoendoscopy	Traditionally used for demarcation of EGC before resection	Few prospective studies are available, and more data will be needed	There are heterogeneity in the types of stain, technique of staining, classification in defining mucosal patterns
NBI	Good for characterization of a focal lesion detected on WLE May be useful for real-time diagnosis of H. pylori Appears reliable for diagnosis of intestinal metaplasia High specificity for characterization of EGCs May be useful for prediction of histological differentiation, prediction of depth of invasion, and in determination of horizontal extent of EGCs	Multiple prospective comparative study show good evidence in support of NBI for diagnosis of intestinal metaplasia and characterization of EGCs More evidence will be needed for other indications	Identifying intestinal metaplasia appears straightforward A variety of classifications for different mucosal pattern bring difficulty in generalization of NBI
FICE	May be useful for diagnosis of focal gastric lesions	Not much comparative prospective data is available
I-SCAN		No comparative data for use of I-SCAN in stomach
Blue-laser imaging	Is expected to be used in similar manner as NBI	Data mainly based on case series rather than comparative studies	Based on anecdotal experience it is similar to NBI and therefore would be expected to provide similar outcomes

WLE: White light endoscopy; EGC: Early gastric cancer; NBI: Narrow-band imaging; FICE: Flexible spectral imaging color enhancement; BNI: Narrow band imaging; H. pylori: Helicobacter pylori.