Clinical Endoscopy

Role of image-enhanced endoscopy for the diagnosis of gastric intestinal metaplasia: Sang Pyo Lee, Shin Hee Kim; Clin Endosc 2026;59(4):523-528. Published online February 13, 2026; DOI: https://doi.org/10.5946/ce.2025.260

Abstract PDF: Gastric intestinal metaplasia (IM) is a key precursor lesion in gastric cancer progression, as described by the Correa model. Image-enhanced endoscopy (IEE) with magnifying endoscopy has significantly improved the visualization of the mucosal surfaces and microvascular structures, aiding in the accurate diagnosis of IM. While histological evaluation remains the gold standard, IEE might provide a practical and cost-effective alternative for the risk stratification of gastric IM.

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Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis: Vishali Moond, Pradeep Yarra, Mannat Bhatia, Sheza Malik, Vineel Malavarappu, Hassam Ali, Saurabh Chandan, Douglas G. Adler, Babu P. Mohan; Clin Endosc 2025;58(3):377-385. Published online March 31, 2025; DOI: https://doi.org/10.5946/ce.2024.211

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line.
Methods
We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics.
Results
Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia.
Conclusions
Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.

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Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes
Natalie J. Wilson, Nicholas Mordan, Cole Potrock, Nicholas J. Shaheen
American Journal of Gastroenterology.2026; 121(2): 302. CrossRef
Barrett's Esophagus
Antonio Al Hazzouri, Philippe Attieh, Tony Azizi, Karl Kfoury, Kelly Katherine Karam, Karam Karam, Elias Fiani
Journal of Gastroenterology and Hepatology.2026; 41(1): 41. CrossRef

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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

Graphical Abstract Abstract PDF

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.

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Complete versus Incomplete Gastric Intestinal Metaplasia
Osman Yilmaz, Vikram Deshpande
Surgical Pathology Clinics.2026; 19(3): 369. CrossRef
Diagnosis of Gastric Intestinal Metaplasia: Histology, Endoscopy, and Artificial Intelligence
Byeong Yun Ahn, Ji Yoon Kim, Hyunsoo Chung
Digestion.2026; : 1. CrossRef
Role of image-enhanced endoscopy for the diagnosis of gastric intestinal metaplasia
Sang Pyo Lee, Shin Hee Kim
Clinical Endoscopy.2026; 59(4): 523. 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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Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis: Sagar N. Shah, Nabil El Hage Chehade, Amirali Tavangar, Alyssa Choi, Marc Monachese, Kenneth J. Chang, Jason B. Samarasena; Clin Endosc 2023;56(1):38-49. Published online January 30, 2023; DOI: https://doi.org/10.5946/ce.2022.179

Abstract PDF Supplementary Material

Background
/Aims: Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
Methods
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Results
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%).
Conclusions
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

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Julius Mueller, Armin Kuellmer, Arthur Schmidt, Moritz Schiemer, Robert Thimme, Benjamin Walter
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Safety and feasibility of argon plasma coagulation for gastric low-grade dysplasia: a systematic review and meta-analysis
Jun-young Seo, Sun Jae Moon, Ah Young Lee, Ji Yong Ahn
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Hongrui Wang, Jiuzhou Zhao, Yu Zhou
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Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis
Maria Manuela Estevinho, Rolando Pinho, João Carlos Silva, João Correia, Pedro Mesquita, Teresa Freitas
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José Manuel Palma García, Raúl Honrubia López, Cristina Fernández de Castro, Carmen Comas Redondo
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef
Thermal ablative therapies in the gastrointestinal tract
Hendrik Manner
Current Opinion in Gastroenterology.2023; 39(5): 370. CrossRef
Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma
Leonardo Henry Eusebi, Andrea Telese, Chiara Castellana, Rengin Melis Engin, Benjamin Norton, Apostolis Papaefthymiou, Rocco Maurizio Zagari, Rehan Haidry
Cancers.2023; 15(19): 4776. CrossRef
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Felice Schnoll-Sussman
Foregut: The Journal of the American Foregut Society.2023; 3(3): 314. 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

Abstract PDF Supplementary Material

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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Tsung-Hsien Chiang, Yen-Ning Hsu, Min-Han Chen, Yi-Ru Chen, Hsiu-Chi Cheng, Mei-Jin Chen, Fu-Jen Lee, Chi-Yang Chang, Chun-Chao Chang, Ming-Jong Bair, Jyh-Ming Liou, Chiuan-Jung Chen, Yen-Chung Chen, Hung Chiang, Chia-Tung Shun, Jui-Hsuan Liu, Han-Mo Chiu
Endoscopy.2026; 58(04): 343. CrossRef
A Benchmark Dataset of Endoscopic Images and a Novel Deep Learning Method to Segment Gastric Intestinal Metaplasia Under Linked Color Imaging
Mingya Zhang, Liang Wang, Yue Yu, Ling Liu, Xianping Tao, Limei Gu, Tingsheng Ling
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Diagnosis of Gastric Intestinal Metaplasia: Histology, Endoscopy, and Artificial Intelligence
Byeong Yun Ahn, Ji Yoon Kim, Hyunsoo Chung
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An interpretable deep learning framework for intestinal metaplasia detection in gastric histopathology images
Alia Al-Mohtaseb, Fahad T. Alotaibi, Salem Alhatamleh, Hatem Malkawi, Amal Alishwait, Ala Meshal Aljehani, Rola Madain, Mohammad Amin
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Boundary-guided VMUNet for atrophic gastritis lesion segmentation in magnifying endoscopy with narrow-band imaging
Xiaoyu Chen, Kun Jiang, Xiufeng Su, Liyong Ma
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Piyush Nathani, Prateek Sharma
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Hu Chen, Shi-yu Liu, Si-hui Huang, Min Liu, Guang-xia Chen
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Na Li, Jian Yang, Xiaodong Li, Yanting Shi, Kunhong Wang, Chih-Wei Tseng
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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
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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

Abstract PDF

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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Peng Pan, Jie Gao, Yu Zhang, Jin-Yan Pan, Wen-Hua Zhang, Nan-Nan Wang, Jiu-Long Zhao, Zhi-Xia Dong, Zhi-Hua Xiao, Zhen-Dong Jin, Zhao-Shen Li, Yu Bai
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Endoscopy International Open.2022; 10(04): E297. CrossRef
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Yuna Kim, Hyunki Kim, Minkyu Jung, Sun Young Rha, Hyun Cheol Chung, Sang Kil Lee
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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

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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A Case of Squamous Metaplasia of the Stomach: Moo Song Jeon, Gwang Ha Kim, Do Youn Park, Jae Hoon Jeong, Dong Hwahn Kahng, Hye Yoon Jang, Jong Hyun Choi, Eun Kyoung Park; Clin Endosc 2013;46(4):407-409. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.407

Abstract PDF

Intestinal metaplasia of the stomach is a common metaplastic lesion associated with chronic gastritis and mucosal atrophy. However, squamous metaplasia is a comparatively rare condition. On endoscopy, squamous metaplasia is usually observed as a whitish mucosal lesion in the lesser curvature of the cardiac region of the stomach. When Lugol's iodine solution is applied, the lesion stains brown in the same way as normal esophageal mucosa. We report a case of 79-year-old man with a whitish flat lesion in the lesser curvature of the cardiac region on surveillance endoscopy after endoscopic treatment of gastric adenoma. The endoscopic biopsy showed stratified squamous epithelial mucosa.

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Expression of MUC5AC and Trefoil Peptide 1 (TFF1) in the Subtypes of Intestinal Metaplasia: Joo-Yong Song, Byung-Wook Kim, Ah-Won Lee, Kyo-Young Lee, In-Sik Chung, Bo-In Lee, Hwang Choi, Jeong-Seon Ji, Hiun-Suk Chae, Kyu-Yong Choi; Clin Endosc 2012;45(2):151-154. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.151

Abstract PDF

Background/Aims

Alterations of the expression pattern of mucins and trefoil peptides have been described in gastric adenocarcinomas and in their precursor lesions. The aim of this study was to determine the progression patterns of intestinal metaplasia (IM) subtypes by analyzing the expression patterns of TFF1 and MUC5AC in different subtypes of IM of the stomach.

Methods

Endoscopic gastric biopsies of the antrum and body were obtained from patients with dyspepsia and endoscopic IM. Alcian blue/periodic acid-Schiff staining and the high iron diamine technique were used to classify the subtypes of IM. Immunoreactivity for MUC5AC and TFF1 was estimated in different types of IM.

Results

IM was detected in 128 samples from 80 patients; type I was found in 48 samples, type II was found in 37 samples, and type III was found in 43 samples. There was a gradual decrease in MUC5AC and TFF1 expression during the progression of IM from type I to type III via the type II intermediate.

Conclusions

This downregulation of MUC5AC and TFF1 expression may challenge the sequential progression of IM from type I to type III via the type II intermediate, and it might be associated with gastric carcinogenesis.

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A Cell Marker Atlas to Distinguish Metaplastic Transitions in Human Esophagus and Stomach
Karen J. Dunbar, Su-Hyung Lee, Yoonkyung Won, Emily M. Esquea, Jeong Yun Yang, Daniel O. Kechele, Sandra Ryeom, Julian A. Abrams, Frank D. McKeon, James M. Wells, Micheal Quante, Eunyoung Choi, Jianwen Que, Timothy C. Wang, Anil K. Rustgi, James R. Golden
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Sergii Vernygorodskyi, Anton B. Tonchev, Kameliya Zhechkova Bratoeva
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Clinicopathologic Features of the Duodenum Related to the Genesis of Duodenal Gastric Metaplasia: Tae Jung Jang, M.D.; Korean J Gastrointest Endosc 2010;41(4):196-200. Published online October 30, 2010

Abstract PDF: Background
/Aims: It has been suggested that gastric metaplasia in the duodenum is prerequisite for duodenal ulcer. The aim of this study was to investigate the role of clinicopathologic parameters of the duodenum such as endoscopic diagnosis, pathologic findings and Helicobacter pylori (H. pylori) infection on the development of gastric metaplasia.
Methods
Endoscopic records as well as pathologic findings of 390 patients were reviewed. The degree of gastric metaplasia in duodenum was evaluated. H. pylori infection was determined by immunohistochemical staining.
Results
The degree of gastric metaplasia was higher in duodenal ulcers and hyperplastic duodenal polyps than in chronic duodenitis. The degree of gastric metaplasia was closely related to severe acute inflammation, mild chronic inflammation and H. pylori infection in duodenum. Duodenal ulcers showed higher acute inflammation and a higher incidence of H. pylori infection than hyperplastic polyps and chronic duodenitis.
Conclusions
Gastric metaplasia in duodenal ulcers may be related to duodenal inflammation and H. pylori infection, whereas in hyperplastic polyps gastric metaplasia may occur by another mechanism. (Korean J Gastrointest Endosc 2010;41:196-200)

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Endoscopic Features of Ectopic Gastric Mucosa in the Duodenum: Hae Jung Song, M.D., Ji Hyun Lee, M.D., In Seop Jung, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sung Kim, M.D. and So Young Jin, M.D.*; Korean J Gastrointest Endosc 2006;32(4):246-252. Published online April 30, 2006

Abstract PDF: Background
/Aims: The origin of gastric mucosa outside of the stomach may be developmental (heterotopic gastric mucosa) or acquired (gastric metaplasia). The aim of this study was to evaluate the endoscopic features, according to the subtypes, of the gastric mucosa outside the stomach in the duodenum. Methods: A total of 30 consecutive patients who underwent esophagogastroduodenoscopy from January 2002 to August 2004 and who were confirmed histopathologically as having gastric mucosa outside the stomach were retrospectively analyzed. Twenty three patients were males and seven were females. Results: Nine patients had heterotopic gastric mucosa and 21 patients had gastric metaplasia. Seven patients with heterotopic gastric mucosa were asymptomatic and 2 patients had dyspepsia, whereas 21 patients with gastric metaplasia had dyspepsia. The dyspepsia rate showed a significant difference between the two groups (p＜0.001). Endoscopically, the appearance of the heterotopic gastric mucosa tended to resemble area gastricae (p=0.08). However, there were no statistically differences between the two groups for the endoscopic features of the duodenum. Other abnormal lesions in stomach and duodenum appeared more frequently in the gastric metaplasia than in the heterotopic gastric mucosa (p=0.004, p＜0.001). There was no difference in the prevalence of Helicobacter pylori infection between the two groups. Conclusions: There are no specific endoscopic findings to differentiate heterotopic gastric mucosa from gastric metaplasia. The presence of symptoms and the associated gastroduodenal inflammatory lesions were more prominent in the gastric metaplasia compared with the heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2006;32:246⁣252)

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59세 남자, 식후 상복부 불쾌감: Korean J Gastrointest Endosc 2003;26(5):352-352. Published online May 30, 2003

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37세 여자, 6개월간의 소화불량: Korean J Gastrointest Endosc 2003;26(5):331-331. Published online May 30, 2003

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만성 위염에서 장상피화생의 아형 ( Subtypes of Intestinal Metaplasia in Chronic Gastritis ): Korean J Gastrointest Endosc 2000;21(2):593-601. Published online November 30, 1999

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Genta 염색을 이용한 위점막 장상피화생 부위의 Helicobacter pylori 부착 빈도 ( Adherence of Helicobacter pylori to Areas of Gastric Intestinal Metaplasia by the Genta Stain ): Korean J Gastrointest Endosc 2000;20(1):1-5. Published online November 30, 1999

Abstract PDF: Background
/Aims: Infection with Helicobacter pylori is the most important cause of chronic active gastritis. One means of evolution of chronic active gastritis is the development of atrophic gastritis, a condition almost universally associated with extensive intestinal metaplasia. But Helicobacter pylori is not usually found in areas of intestinal metaplasia. Recently Genta RM developed a staining technique that allows simultaneous visualization of Helicobacter pylori and gastric morphology, including intestinal metaplasia. Therefore, the evaluation of the frequency of Helicobacter pylori adherence to intestinal metaplasia using the Genta stain is herein reported. Methods: The study was conducted on 69 gastric biopsy specimens with intestinal metaplasia. Slides from each specimen were stained using the Genta stain to identify the adherence of bacteria and types of intestinal metaplasia. Results: In 56 (81%) of 69 patients, incomplete intestinal metaplasia was found. In 9 (16%) of 56 patients with incomplete intestinal metaplasia, H. pylori was attached in the area of intestinal metaplasia. But in all of the intestinal metaplasia, H. pylori was not attached in the area of the intestinal metaplasia Conclusions: The common subtype of intestinal metaplasia was incomplete metaplasia. Although in small cases, H. pylori was attached only to the area of the incomplete type of intestinal metaplasia. (Korean J Gastrointest Endosc 2000;20:1~ 5)

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메틸렌 블루 색소내시경과 조직학적으로 확인된 장상피화생에서 Helicobacter pylori 양성률에 대한 연구 (The Study of the Positivity of Helicobacter pylori in the Intestinal Metaplasia Detected by Methylene Blue Chromoendoscopy and Histology): Korean J Gastrointest Endosc 1999;19(2):193-199. Published online November 30, 1998

Abstract PDF: Background
/Aims: To assess the relationship between the intestinal metaplasia, Helico-bacter pylori infection, and H. pylori positivity, the difference in the type of intestinal metaplasia according to H. pylori status were examined. Methods: Chromoendoscopy by methylene blue stain method was performed to assess the diagnostic viability for the detection of intestinal metaplasia in subjects who having histologically determined intes-tinal metaplasia. Results: Intestinal metaplasia was found in 35 subjects. Of these, 21subjects (60%) were male and 14 subjects (40%) were female. Of 35 subjects, 26 subjects were H. pylori positive cases (74.3%) and 9 subjects were H. pylori negative cases (25.7%). The mean age of intestinal metaplasia subjects was 51.5 8.9 years. Of these, the mean age of H. pylori positive subjects was 49.5 8.0 years, whereas the mean age of H. pylori negative subjects was 57.2 9.2 years (p ＜0.05). On the type of intestinal metaplasia, 31 subjects showed type I (88.6%) and 4 subjects showed type II (11.4%). There was no statistical difference of intestinal metaplasia type according to H. pylori status. The diagnostic value of methylene blue chromoendoscopy in the diagnosis of intestinal metaplasia had a sensitivity of 82.4%, specificity of 100%, positive predictivevalue of 100% and negative predictive value of 75%. Conclusions: Although a causal relationship between H. pylori infection and the histogenesis of intestinal metaplasia was not proven, it is suggested that H. pylori positive cases lead to an earlier development of intestinal metaplasia than H. pylori negative cases. Therefore, it is important to assess the probability of the development of gastric carcinoma through a follow up study. (Korean J Gastrointest Endosc 19: 193 ∼199, 1999)

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전정부와 체부에서의 H. pylori 진단율과 장상피화생 ( The Detection Rate of H. pylori and Intestinal Metaplasia in the Antrum and in the Body ): Korean J Gastrointest Endosc 1999;19(1):9-17. Published online November 30, 1998

Abstract PDF: Aims: In this paper we have investigated the detection rate of each H. pylori test in the antrum and in the body for patients with nonulcer dyspepsia (NUD), duodenal ulcer (DU), benign gastric ulcer (BGU), and stomach cancer. In addition, we examined whether or not there is any relationship between the decrease of H. pylori detection rate and intestinal metaplasia in the antrum. Methods: Three different test methods for identifying H. pylori infection-CLOtest, Gram stain, H&E stain-were taken in the antrum and in the body. Results: 1) The detection rates of CLOtest, Gram stain, and H&E stain for NUD group were 88%, 75%, and 64% (mean: 76%) in the antrum, and 89%, 78%, and 67% (mean: 78%) in the body, respectively, and those of DU group were 95%, 95% and 81% (mean: 90%) in the antrum, and 97%, 87% and 64% (mean: 83%) in the body, respectively. Those of BGU group were 86%, 74%, 53% (mean: 71%) and 98%, 82%, 58% (mean: 79%), respectively, and those of stomach cancer group were 80%, 88%, 58% (mean: 75%) in the antrum, and 100%, 96%, 83% (mean: 93%) in the body, respectively. The B/A detection ratio which means the ratio of mean H. pylori detection rate of body to that of antrum was 1.03 in NUD, 0.93 in DU, 1.11 in BGU, and 1.24 in stomach cancer group. 2) The rate of intestinal metaplasia in the antrum was 12% for NUD, and 15% for DU group. Those of BGU and stomach cancer group were 47% and 72%, respectively. 3) The correlation etween B/A detection ratio and intestinal metaplasia in the antrum was good (correlation coefficient(r)=0.93). Conclusions: The result that body is more adequate for H. pylori detection in BGU and stomach cancer patients rather than antrum can be explained by the high rate of intestinal metaplasia in the antrum which is hostile surrounding for H. pylori. (Korean J Gastrointest Endosc 19: 0 ∼0, 1999)

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증례 : 식도 위장관 ; 십이지장구부에 발생한 용종양 위상피화생 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Polypoid Gastric Metaplasia in Duodenal Bulb ): Korean J Gastrointest Endosc 1996;16(4):644-649. Published online November 30, 1995

Abstract PDF: Gastric metaplasia of the duodenum, defined as the presence of groups of gastric mucosal cell within normal duodenal epithelium, is an almost constant feature of duodenal ulcer. The pathogenesis of gastric metaplasia is unclear, but acid and Helicobacter pylori infection are contributory factors to the development of gastric metaplasia. Generally, endoscopic finding of gastric metaplasia in duodenum is typically patchy distribution in duodenal bulb, but polypoid gastric metaplasia in duodenum is very rare. We report that the patient who complaints of abdominal pain has a villous, polypoid gastric metaplasia in duodenal bulb without duodenal ulcer. (Korean J Gastrointest Endosc 16: 644~848, 1996)

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