Summary table of advanced endoscopic imaging modalities
| Methodology | Manufacturers | Clinical performance | Comments | |
|---|---|---|---|---|
| Autofluorescence imaging (AFI) | Based on detection of natural tissue fluorescence emitted by endogenous molecules, to differentiate between normal non-dysplastic tissue (green) and dysplastic tissue (purple) | Olympus Medical Systems; Evis Exera II/III processors | Few studies to demonstrate increase diagnostic yield of gastric cancer and gastric intestinal metaplasia | Inadequate clinical evidence to support routine use of AFI in clinical practice |
| Fuji intelligent chromo endoscopy (FICE) | Video processor synthesises three single-wavelength images to display a composite colour-enhanced image in real-time. 10 preset settings available | Fujinon; Series 500 gastroscopes; VP-4450HD and VP-4400HD processors | No standardised definitions of gastric preneoplastic and neoplastic lesions. Single meta-analysis of seven studies showing more colour contrast compared with WLE alone for gastric cancer and gastric intestinal metaplasia | More clinical evidence required before routine application in clinical practice for gastric lesions |
| i-Scan | Post imaging video processor to provide enhanced images of mucosal surface and blood vessels. three presets mode using a combination of (1) surface enhancement, (2) contrast enhancement and (3) tone enhancement modes | PENTAX Endoscopy; Series I and 90K gastroscopies, EPK-i5010 processor | No standardised definitions of gastric preneoplastic and neoplastic lesions. Few studies to demonstrate better image quality and recognition of gastric cancer and gastric intestinal metaplasia | More clinical evidence required before routine application in clinical practice for gastric lesions |
| Narrow band imaging (NBI) | Placement of NBI filter produces two bands of lights to differentiate between capillaries in the superficial mucosa (brown, 415 nm) and deeper veins in the mucosa/submucosa (cyan, 540 nm) | Olympus Medical Systems; Evis Exera II/III processors | Established NBI classification for gastric lesions and neoplasia. Abundant studies and meta-analysis data available to demonstrate accurate characterisation and diagnostic yield of gastric intestinal metaplasia and gastric cancer | Recommended by ESGE to better improve diagnostic yield of gastric cancer and gastric preneoplastic lesions |
| Blue light imaging (BLI) | Two lasers and a while light phosphor for illumination, with one laser at 450 nm for white light illumination, and another laser at 410 nm to mucosal blood vessels | Fujinon; VP-4450HD processor | Established NBI classification for gastric lesions and neoplasia may be applied. Has two modes (1) contrast mode for magnifying images, (2) bright mode for far view surveillance. Excellent endoscopic images, but few prospective studies | More clinical evidence required before routine application in clinical practice for gastric lesions |
| Confocal laser endomicroscopy (CLE) | Tissue illumination with a low-power laser with subsequent detection of fluorescence of light reflectance |
| Promising results in improving diagnostic yield of gastric cancer, intestinal metaplasia and Helicobacterpylori-related gastritis. Potentiate the need for fewer biopsies to confirm presence of gastric intestinal metaplasia | Adequate training required for accurate CLE diagnosis |
| Endocytoscopy (ECS) | Fixed-focus, high-power objective lens that project highly magnified images | Olympus Medical Systems;
| Data from limited number of studies available, but promising results in diagnosing cancer and intestinal metaplasia accurately | More clinical evidence required before routine application in clinical practice for gastric lesions |