Hue-texture-embedded region-based model for magnifying endoscopy with narrow-band imaging image segmentation based on visual features

Objective To evaluate the clinical value of narrow band imaging(NBI)for diagnosis of malignant and premalignant gastric lesions.Methods The gastric lesions,pits and microvascularity were observed using conventional endoscopy followed by narrow band imaging(NBI)and chromoendoscopy(0.2%indigo carmine)as well as magnifying endoscopy(×80)in 217 patients.The quality of images obtained by different endoscopies was evaluated and compared to pathologic interpretations. Results Of 217 patients,non-atrophic gastritis was found in 85 cases,chronic atrophic gastritis in 38 cases,mild dysplasia in 19 cases,moderate dysplasia in 9 cases,severe dysplasia in 4 cases,early gastric cancer in 5 cases,advanced gastric cancer in 20 cases and intestinal metaplasia in 91 cases.The NBI endoscopy was superior to conventional endoscopy and chromoendoscopy in finding gastric lesions(P=0.000).The gastric microvascularity was more clearly seen on images obtained by NBI combined with magnifying endoscopy in comparison with conventional endoscopy and chromoendoscopy(P=0.000).There were six patterns in description of gastric pits with NBI endoscopy.Type Ⅲ,Ⅳ or Ⅴ1 was usually found in chronic atrophic gastritis,type Ⅲ,Ⅳ,Ⅴ1 or Ⅴ2 in intestinal metaplasia,type V1 or Ⅳ in dysplasia and type Ⅵ in suspected malignant lesion.Conclusions NBl with magnifying endoscopy is helpful in improving the biopsy accuracy of malignant and dysplastic lesions and in detecting early gastric cancer. Key words: Stomach neoplasms; Gastroscopy; Diagnosis

Fine-tuning Pre-trained Convolutional Neural Networks for Gastric Precancerous Disease Classification on Magnification Narrow-band Imaging Images

Narrow band imaging (NBI) and NBI-magnifying endoscopy (ME) have been reported to facilitate the diagnosis of intestinal metaplasia (IM) and early gastric cancer (EGC) in high-risk populations. This study aimed at comparing the detection rate of focal gastric lesions by NBI against white light endoscopy (WLE), and examined the utility of NBI-ME in differentiating gastric mucosal pathology in a population with intermediate gastric cancer risk. Chinese patients aged 35-70 years undergoing diagnostic gastroscopy (GIF FQ260Z) by six experienced endoscopists were enrolled prospectively. The sequence of endoscopic evaluation was WLE followed by NBI. Focal lesions were re-examined by NBI-ME. The incremental diagnostic yield of NBI over WLE and ability of NBI-ME to differentiate gastric mucosal pathology were analyzed. Over a 30-month period, 458 patients (mean age: 52 years; men: 53.7%; Helicobacter pylori positive: 20.1%) were recruited. WLE detected a focal gastric lesion in 43.7% (200/458). WLE made a definitive diagnosis in 148 out of 200 patients (147 benign lesions and one gastric cancer), whereas NBI-ME correctly clarified the nature of the remaining 52 lesions (benign: 51; EGC: one). NBI detected an additional 69 out of 458 lesions (type 0_IIa: 91.3%; type 0_IIb: 8.7%) missed by WLE; the diagnoses based on NBI-ME were IM (67/69), EGC (1/69), and benign lesion (1/69). Interobserver agreement study revealed a κ statistic of 0.71. NBI detected IM missed by WLE. NBI-ME was useful in differentiating the pathology of focal gastric mucosal lesions.

PurposeClinical application of narrow band imaging facilitates diagnosis of esophageal neoplasia. However, no previous investigation has been conducted on magnifying endoscopy combined with narrow band imaging in detection of minimal superficial esophageal neoplasia, which is defined as neoplasia <10 mm in diameter. The aim of this retrospective study was to evaluate the usefulness of this combined technique in the differential diagnosis of minimal superficial esophageal neoplasia.MethodsBetween January 2005 and November 2011, 53 minimal superficial esophageal neoplasias in 40 patients were diagnosed by screening upper gastrointestinal endoscopy with narrow band imaging at our hospital. We investigated findings including brownish dots, brownish epithelium, and demarcation line of minimal superficial esophageal neoplasia diagnosed histopathologically as low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, and squamous cell carcinoma.ResultsSignificantly more brownish dots (P < 0.05) and brownish epithelium (P < 0.005) were observed in intraepithelial papillary capillary loops in high-grade neoplasia compared with low-grade neoplasia. When minimal superficial esophageal neoplasia was diagnosed as high-grade intraepithelial neoplasia or squamous cell carcinoma, sensitivity, specificity, positive predictive value, and negative predictive value were 88.9, 42.9, 44.4, and 88.2 %, respectively, for brownish dots; 94.4, 51.4, 50.0, and 94.7 %, respectively, for brownish epithelium; and 66.7, 62.9, 48.0, and 78.6 %, respectively, for demarcation line.ConclusionsThe combined technique was useful in the differential diagnosis of minimal superficial esophageal neoplasia.

Gastric cancer (GC) is characterized by high morbidity and mortality rates worldwide. Helicobacter pylori infection, high salt intake, smoking, alcohol, low fiber intake, family history of GC, obesity and precancerous lesions, including chronic atrophic gastritis and intestinal metaplasia, are considered general risk factors for GC. Image enhancement endoscopy methods, which improve the visualization of mucosal structures and vascularity, may be used for the early diagnosis of GC, such as narrow band imaging, which can reveal fine details of subtle superficial abnormalities of early gastric cancer (EGC). Mitochondria are well-known for their role in producing ATP via the tricarboxylic acid cycle. In cancer cells, the energetic metabolism can be reprogrammed as anaerobic glycolysis for energy production and anabolic growth. In addition to their dominant metabolic functions, mitochondria participate in several central signaling pathways, such as the apoptotic pathway and NLRP3 inflammasome activation. Conversely, mitochondrial dynamics, including fission/fusion and mitophagy, can also contribute to the pathogenesis of cancer. The dysfunction and dysregulation of mitochondria have been associated with several ageing and degenerative diseases, as well as cancer. The present review focuses on energy metabolism and mitochondrial dynamics, and summarizes the changes in gastric carcinogenesis, the diagnosis of EGC and indicates potential targeted treatments.

Objective To evaluate the diagnostic value of blue laser imaging(BLI) combined with magnifying endoscopy for precancerous lesions and early gastric cancers. Methods From September 2015 to May 2016, a total of 249 gastric lesions detected with conventional white light endoscopy (WLE) on the basis of the assessment of mucosal shape and color were enrolled in this study. The pathological results were used as golden standard, and diagnostic accuracy rates of precancerous lesions or early cancers by white light magnification alone, BLI-contrast magnification and BLI-bright magnifier were determined according to the VS criteria. The concordance between endoscopic diagnosis and pathological diagnosis was evaluated through the agreement (Kappa) test, and diagnostic value was compared with McNemar paired Chi-square test. Results Pathological examination showed chronic gastritis in 149 lesions, intestinal metaplasia in 67, low grade intra-epithelial neoplasia in 8, and high grade intra-epithelial neoplasia or early cancer in 25.The concordance rates of lesions were 76.7% for white light magnification alone, 85.1% for BLI-contrast magnification, and 86.7% for BLI-bright magnification.Kappa values were 0.571, 0.730, and 0.760 respectively.For the screening of high grade intra-epithelial neoplasia or early cancer, the diagnostic sensitivities were 72.0%, 92.0%, and 92.0%, respectively, the specificities were 95.5%, 98.2%, and 99.1%, the consistencies were 93.2%, 97.6%, 98.4%, and the Kappa values were 0.642, 0.871, and 0.911. In contrast to white light magnification alone, the concordance between endoscopic diagnosis and pathological diagnosis of BLI-contrast magnification and BLI-bright magnification was significantly higher(P<0.05). And in the diagnosis of high-grade intraepithelial neoplasia or early gastric cancer, the concordance between endoscopic diagnosis and pathological diagnosis of BLI-contrast magnification and BLI-bright magnification was higher than that of white light magnification alone(P<0.05). Conclusion BLI combined with magnifying endoscopy may improve the diagnostic accuracy of early gastric cancer and precancerous lesions. Key words: Stomach neoplasms; Endoscopy, gastronintestinal; Diagnosis; Blue laser imaging; Magnifying endoscopy

Dissecting the Single-Cell Transcriptome Network Underlying Gastric Premalignant Lesions and Early Gastric Cancer

Su1242 Clinical Significance of Colonoscopic Examination in Patients With Early Gastric Cancer

ObjectiveTo identify whether bile reflux on endoscopy and other related variables are risk factors for precancerous gastric lesions and gastric cancer (GC).MethodsA multicenter, cross‐sectional and observational study was conducted in five centers in China from June to October 2019, 1162 patients were recruited and divided into the chronic gastritis (CG), the precancerous lesion (low‐grade intraepithelial neoplasia and intestinal metaplasia), and GC groups (including high‐grade intraepithelial neoplasia). All participants underwent detailed interviews, endoscopy and biopsy, and completed questionnaires. Odds ratio and 95% confidence interval were calculated with multivariate logistic regression models with or without adjustment for Helicobacter pylori infection.ResultsWe recruited 668 patients with CG, 411 with precancerous lesions and 83 with GC. By comparing the CG and precancerous lesion groups, independent risk factors for cancerous gastric lesions were the grade of bile reflux, patient's age, dietary habits and family history of GC. Similar results were obtained when comparing the CG and GC groups. In addition, bile reflux was confirmed as an independent risk factor for progression from precancerous lesions to cancer.ConclusionsBile reflux on endoscopy as well as age, dietary habits and a family history of GC were independent risk factors for the development of precancerous gastric lesions and GC.

Background:Helicobacter pylori related gastric intestinal metaplasia (IM) is considered to be a precancerous lesion. Aims: To identify the effects of H pylori eradication on K-ras mutations, cell kinetics in IM...

Optical imaging technologies expand gastrointestinal endoscopy beyond white-light endoscopy (WLE), improving visualization of mucosal, vascular, and subsurface features. They are applied to the detection of neoplastic and premalignant lesions, inflammatory diseases, and small bowel and pancreatic disorders, though their validation and readiness for routine practice vary. This review critically evaluates both guideline-endorsed and investigational optical imaging techniques across major gastrointestinal indications, highlighting diagnostic performance, level of validation, current guideline recommendations, and practical challenges to adoption. In Barrett’s esophagus, narrow-band imaging (NBI) is guideline-endorsed, while acetic acid chromoendoscopy is validated in expert centers. For gastric intestinal metaplasia and early gastric cancer, magnifying NBI achieves diagnostic accuracies exceeding 90% and is guideline-recommended, with acetic acid chromoendoscopy aiding in margin delineation. In inflammatory bowel disease, dye-spray chromoendoscopy is the reference standard for dysplasia surveillance, with virtual methods such as NBI, FICE, and i-SCAN serving as practical alternatives when dye application is not feasible. In the colorectum, NBI supports validated optical diagnosis strategies (resect-and-discard, diagnose-and-leave), while dye-based chromoendoscopy improves detection of flat and serrated lesions. Capsule endoscopy remains the standard for small bowel evaluation of bleeding, Crohn’s disease, and tumors, with virtual enhancement, intelligent chromo capsule endoscopy, and AI-assisted interpretation emerging as promising adjuncts. Pancreaticobiliary applications of optical imaging are also advancing, though current evidence is still preliminary. Investigational modalities including confocal laser endomicroscopy, optical coherence tomography, autofluorescence, Raman spectroscopy, and fluorescence molecular imaging show potential but remain largely restricted to research or expert settings. Guideline-backed modalities such as NBI and dye-based chromoendoscopy are established for clinical practice and supported by robust evidence, whereas advanced techniques remain investigational. Future directions will rely on broader validation, integration of artificial intelligence, and adoption of molecularly targeted probes and next-generation capsule technologies, which together may enhance accuracy, efficiency, and standardization in gastrointestinal endoscopy.

Objective To evaluate the use of magnifying endoscopy combined with narrow band imaging （NBI） system in diagnosis of early gastric cancer. Methods From March 2008 to December in 2008, a total of 56 patients with suspected gastric mucosal lesions were enrolled in the study. The lesions were observed with magnifying endoscopy combined with NBI and indigo-earmine-chromoendoscopy, and the results were compared with pathologic diagnosis from targeted biopsies. Results Out of 56 patients, 16 were diagnosed as early gastric cancer pathologically. The accordance rate with the pathological diagnosis, sensibility, specificity, false positive rate and false negative rate of the magnifying endoscopy combined with NBI system were 94. 6% （53/56）, 93.8% （ 15/16）, 95.0% （38/40）, 5.0% （2/40） and 6. 3% （ 1/16）, respectively; while those of chromoendoscopy were 91.1% （51/56） , 87. 5% （14/16）, 92. 5% （37/40） , 7.5% （3/40） and 12. 5% （2/16）, respectively （P 〉 0. 05）. There was no difference between NBI and chromoendoscopy in regarding of observing pit pattern, however, NBI was superior in displaying intrapapillary capillary loop. Conclusion Combination of magnifying endoscopy and NBI provides clear images of gastric mucosa and intrapapillary capillary, which is useful in diagnosis of early gastric cancer and can improve accuracy of biopsy. When combined with chromoendoscopy, it can further improve the yield of diagnosis. Key words: Narrow band imaging; Magnifying endoscopy; Early gastric cancer

B7 negative costimulatory molecules are a group of molecules associated with the occurrence, development, and therapy of cancers. Here, we aimed to determine the clinical significance of PD-L1, B7-H3, and B7-H4 and their expression in CD8 and CD68 positive cells at different stages of gastric carcinogenesis.We detected PD-L1, B7-H3, B7-H4, CD8, and CD68 expression in samples by immunohistochemical staining of 62 chronic superficial gastritis (CSG) samples, 72 chronic atrophic gastritis (CAG) samples, 68 low-grade intraepithelial neoplasia (LIN) samples, 65 high-grade intraepithelial neoplasia (HIN) samples obtained from gastroscopic biopsies and 50 gastric adenocarcinoma (GA) samples obtained from surgical resections. Then we statistically analyzed the expression differences and correlations.Our results indicated that B7 and CD68 expression on infiltrating immune cells was associated with disease progression. However, infiltration of CD8+ cells decreased with disease progression. B7-H3 expression was markedly enhanced at neoplasia and GA stages. B7-H3 in tumor cells was negatively correlated with CD8-expressing cells. Conversely, B7-H3 expression in tumor-infiltrating immune cells was positively correlated with CD68-expressing cells. B7-H4 expression was found in the cell membrane at the stages of gastritis and low-grade neoplasia and was gradually expressed in the cytoplasm at high-grade neoplasia and GA stages. High B7-H4 expression in infiltrating immune cells was also significantly associated with lower CD8-positive and higher CD68-positive cell densities.Increased B7 protein expression by infiltrating immune cells was associated with disease progression, and specifically, the level of B7-H3 expression and localization of B7-H4 expression differed significantly among different stages of gastric carcinogenesis.

Endoscopic Mucosal Resection: Not Your Father's Polypectomy Anymore

Objective To investigate the morphologic features of gastric intestinal metaplasia (IM)using narrow band imaging(NBI)endoscopy,and its feasibility and accuracy for diagnosis of IM combined with histopathology.Methods The endoscopic examination was performed on 80 patients and suspected lesions associated with IM was further observed by NBI combined with magnifying endoscopy.The biopsy specimens were obtained from regions containing light blue crest(LBC)or non-LBC mucosa for pathological examination,and the results were analyzed.Results In 80 patients examined with NBI,IM was pathologically confirmed in 65 patients.Of which LBC was seen in 61 patients with a sensitivity of 94%and a specificity of 95%.In a total of 94 specimens obtained from LBC region,86 had histological evidence of IM with a positive predictive value of 9 1.49%.There was no evidence of IM in 79 out of 94 specimens obtained from non-LBC region of patients with or without LBC with a negative predictive value of 84.04%.The results indicated that the detective rate of IM could be increased if biopsy specimen was obtained from LBC region with help of NBI endoscopy(P＜0.05).Conclusions It has been demonstrated that NBI combined with magnifying endoscopy may improve the diagnosis of IM by clearly observing microvasculature and targeted-biopsy in LBC region,which is helpful in early diagnosis of gastric cancer. Key words: Gastric mucosa; Metaplasia; Intestinal mucosa; Endoscopic examination