Clinical Endoscopy

Original Articles

Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages: Justyna Wasielica-Berger, Pawel Rogalski, Anna Pryczynicz, Agnieszka Swidnicka-Siergiejko, Andrzej Dabrowski; Clin Endosc 2023;56(2):203-213. Published online March 9, 2023; DOI: https://doi.org/10.5946/ce.2022.087

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Background
/Aims: Intestinal metaplasia (IM) of the stomach is a precancerous condition that is often not visible during conventional endoscopy. Hence, we evaluated the utility of magnification endoscopy and methylene blue (MB) chromoendoscopy to detect IM.
Methods
We estimated the percentage of gastric mucosa surface staining with MB, mucosal pit pattern, and vessel visibility and correlated it with the presence of IM and the percentage of metaplastic cells in histology, similar to the Operative Link on Gastric Intestinal Metaplasia (OLGIM) stage.
Results
IM was found in 25 of 33 (75.8%) patients and in 61 of 135 biopsies (45.2%). IM correlated with positive MB staining (p<0.001) and other than dot pit patterns (p=0.015). MB staining indicated IM with better accuracy than the pit pattern or vessel evaluation (71.7% vs. 60.5% and 49.6%, respectively). At a cut-off point of 16.5% for the MB-stained gastric surface, the sensitivity, specificity, and accuracy of chromoendoscopy in the detection of advanced OLGIM stages were 88.9%, 91.7%, and 90.9%, respectively. The percentage of metaplastic cells detected on histology was the strongest predictor of positive MB staining.
Conclusions
MB chromoendoscopy can serve as a screening method for detecting advanced OLGIM stages. MB mainly stains IM areas with a high concentration of metaplastic cells.

Citations

Citations to this article as recorded by

Complete versus Incomplete Gastric Intestinal Metaplasia
Osman Yilmaz, Vikram Deshpande
Surgical Pathology Clinics.2026;[Epub] CrossRef
Diagnosis of Gastric Intestinal Metaplasia: Histology, Endoscopy, and Artificial Intelligence
Byeong Yun Ahn, Ji Yoon Kim, Hyunsoo Chung
Digestion.2026; : 1. CrossRef
The prediction model of operative link on gastric intestinal metaplasia stage III-IV: A multicenter study
Song Wang, Meng Qian, Min Wu, Shuo Feng, Kaiguang Zhang
Heliyon.2023; 9(11): e21905. CrossRef

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Real-time semantic segmentation of gastric intestinal metaplasia using a deep learning approach: Vitchaya Siripoppohn, Rapat Pittayanon, Kasenee Tiankanon, Natee Faknak, Anapat Sanpavat, Naruemon Klaikaew, Peerapon Vateekul, Rungsun Rerknimitr; Clin Endosc 2022;55(3):390-400. Published online May 9, 2022; DOI: https://doi.org/10.5946/ce.2022.005

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Background
/Aims: Previous artificial intelligence (AI) models attempting to segment gastric intestinal metaplasia (GIM) areas have failed to be deployed in real-time endoscopy due to their slow inference speeds. Here, we propose a new GIM segmentation AI model with inference speeds faster than 25 frames per second that maintains a high level of accuracy.
Methods
Investigators from Chulalongkorn University obtained 802 histological-proven GIM images for AI model training. Four strategies were proposed to improve the model accuracy. First, transfer learning was employed to the public colon datasets. Second, an image preprocessing technique contrast-limited adaptive histogram equalization was employed to produce clearer GIM areas. Third, data augmentation was applied for a more robust model. Lastly, the bilateral segmentation network model was applied to segment GIM areas in real time. The results were analyzed using different validity values.
Results
From the internal test, our AI model achieved an inference speed of 31.53 frames per second. GIM detection showed sensitivity, specificity, positive predictive, negative predictive, accuracy, and mean intersection over union in GIM segmentation values of 93%, 80%, 82%, 92%, 87%, and 57%, respectively.
Conclusions
The bilateral segmentation network combined with transfer learning, contrast-limited adaptive histogram equalization, and data augmentation can provide high sensitivity and good accuracy for GIM detection and segmentation.

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Hu Chen, Shi-yu Liu, Si-hui Huang, Min Liu, Guang-xia Chen
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Jean-Francois Rey
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Na Li, Jian Yang, Xiaodong Li, Yanting Shi, Kunhong Wang, Chih-Wei Tseng
PLOS ONE.2024; 19(5): e0303421. CrossRef
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Passin Pornvoraphat, Kasenee Tiankanon, Rapat Pittayanon, Natawut Nupairoj, Peerapon Vateekul, Rungsun Rerknimitr
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Jie Yang, Yan Ou, Zhiqian Chen, Juan Liao, Wenjian Sun, Yang Luo, Chunbo Luo
IEEE Journal of Biomedical and Health Informatics.2023; 27(1): 7. CrossRef
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Passin Pornvoraphat, Kasenee Tiankanon, Rapat Pittayanon, Phanukorn Sunthornwetchapong, Peerapon Vateekul, Rungsun Rerknimitr
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Journal of Medical Internet Research.2023; 25: e50448. CrossRef

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Focused Review Series: Image Enhanced Endoscopy

Usefulness and Future Prospects of Confocal Laser Endomicroscopy for Gastric Premalignant and Malignant Lesions: Sang Kil Lee; Clin Endosc 2015;48(6):511-515. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.511

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Confocal laser endomicroscopy (CLE) is a new technology enabling endoscopists to visualize tissue at the cellular level. CLE has the fundamental potential to provide a histologic diagnosis, and may theoretically replace or reduce the need for performing biopsy for histology. The clinical benefits of CLE are more obvious in esophageal disease, including Barrett’s esophagus. Currently, this technology has been adapted to the diagnosis and surveillance of Barrett’s esophagus and related neoplasia. Standard white light endoscopy is the primary tool for gastric cancer screening. Currently, the only method available to precisely diagnose these lesions is upper endoscopy with an appropriate biopsy. A recent study showed that CLE could characterize dysplasia or cancer and identify the risk factors for gastric cancer, such as intestinal metaplasia and the presence of Helicobacter pylori in vivo, although fewer studies on CLE were performed on the stomach than on Barrett’s esophagus and other esophageal diseases. However, the application of CLE to routine clinical endoscopy continues to be refined. This review focused on the usefulness and future prospects of CLE for gastric premalignant and malignant lesions.

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Challenges and Prospects of Using Novel Nonlinear Effects in Multimode Optical Fibers for Multiphoton Endomicroscopy
Lidiya V. Boldyreva, Denis S. Kharenko, Kirill V. Serebrennikov, Anna A. Evtushenko, Viktor V. Shloma, Daba A. Radnatarov, Alexandr V. Dostovalov, Zhibzema E. Munkueva, Oleg S. Sidelnikov, Igor S. Chekhovskoy, Kirill S. Raspopin, Mikhail D. Gervaziev, Ste
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Carlos Robles-Medranda, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Juan Alcívar-Vásquez, Raquel Del Valle, Carlos Cifuentes-Gordillo, Haydee Alvarado-Escobar, Daniel Ponce-Velez, Jesenia Ospina-Arboleda, Hannah Pitanga-Lukashok
Endoscopy International Open.2022; 10(04): E297. CrossRef
Probe-Based Confocal Laser Endomicroscopy versus White-Light Endoscopy with Narrow-Band Imaging for Predicting and Collecting Residual Cancer Tissue in Patients with Gastric Cancer Receiving Chemotherapy
Yuna Kim, Hyunki Kim, Minkyu Jung, Sun Young Rha, Hyun Cheol Chung, Sang Kil Lee
Cancers.2022; 14(17): 4319. CrossRef
Usefulness of Probe-Based Confocal Laser Endomicroscopy for Esophageal Squamous Cell Neoplasm
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Clinical Endoscopy.2019; 52(2): 91. CrossRef
High prevalence of gastric intestinal metaplasia detected by confocal laser endomicroscopy in Zambian adults
Violet Kayamba, Aaron Shibemba, Kanekwa Zyambo, Douglas C. Heimburger, Douglas R. Morgan, Paul Kelly, Esaki M. Shankar
PLOS ONE.2017; 12(9): e0184272. CrossRef

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Special Issue Article of IDEN 2013

Confocal Microscopy in the Esophagus and Stomach: Adam Templeton, Joo Ha Hwang; Clin Endosc 2013;46(5):445-449. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.445

Abstract PDF PubReader ePub

Probe-based confocal microscopy (pCLE) is actively being investigated for applications in the esophagus and stomach. The use of pCLE allows real-time in vivo microscopy to evaluate the microarchitecture of the mucosal epithelium. pCLE appears to be particularly useful in identifying mucosal dysplasia and early malignancies that cannot be clearly distinguished using high-definition white light endoscopy, chromoendoscopy, or magnification endoscopy. In addition, the ability to detect dysplastic tissue in real-time may shift the current screening practice from random biopsy to targeted biopsy of esophageal and gastric cancers and their precursor lesions. We will review the use of pCLE for detection and surveillance of upper gastrointestinal early luminal malignancy.

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