Comparison of the effectiveness of i-scan and conventional endoscopy in the detection of the endoscopic signs of atrophic gastritis: A clinical trial

Gastric cancer is among the most common cancer types worldwide [1]. In the cancer cascade described by Correa et al., atrophic gastritis (AG), intestinal metaplasia (IM), low and high-grade dysplasia, and stomach cancer follow one another [2]. AG is characterized by progressive atrophy of the glandular epithelium, accompanied by the loss of parietal cells and chief cells. The prevalence of gastric cancer and AG tend to be correspondingly high or low in a given society, suggesting shared risk factors [3]. IM is an advanced stage of atrophy, since the metaplastic glands eventually replace the original glands, with the metaplastic glands appearing after the loss of the gastric glands. The early detection of precancerous lesions is important to patient prognosis. Therefore, the correct identification, follow-up, and treatment of individuals with AG and IM are essential for the prevention or early diagnosis of gastric cancers [4].

The diagnostic limitations of conventional endoscopy have led to the development of new endoscopic methods for the detection of precancerous gastric lesions. The various novel endoscopic methods now available include flexible spectral-imaging color enhancement, narrow-band imaging (NBI), chromoendoscopy, magnified endoscopy, and i-scan (PENTAX Medical, Tokyo, Japan). These approaches obtain better images of the mucosal layer and the ability to distinguish between benign and malignant lesions.

I-scan is a post-processing image-enhancement technology that allows detailed views of mucosal vascular patterns. The white light images are processed arithmetically into three types of enhancements: surface enhancement (SE), contrast enhancement (CE), and tone enhancement (TE). SE and CE are useful screening methods for the early detection of gastrointestinal lesions, while TE is used to further characterize identified lesions. A button on the endoscope switches between modes and two modes can be displayed simultaneously [5], [6].

A limited number of studies have investigated the effectiveness of i-scan endoscopy, especially in the diagnosis of gastric lesions. This study aimed to determine whether the use of i-scan endoscopy provides additional benefits to conventional endoscopy in the diagnosis of precancerous gastric lesions encountered in endoscopic examinations.

The primary objective of this study was to investigate whether i-scan provides additional benefits in the diagnosis of AG and IM. The secondary objective was to evaluate the effect of i-scan on the mean number of biopsies per patient.

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