Post written by Zhen Li, MD, from the Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China.

We conducted a randomized controlled trial comparing optical enhancement combined with magnification endoscopy (ME-OE) with conventional white-light endoscopy (WLE) for detection of gastric intestinal metaplasia (GIM), gastric intraepithelial neoplasia (GIN), and early gastric cancer (EGC).

Detection of GIM, GIN, and EGC is very important for high-risk patients with gastric cancer. The endoscopic-pathological correlation and interobserver reliability of WLE are unsatisfactory. ME-OE has been developed to examine the microsurface and microvascular features of the suspected lesion. Thus, we sought to rigorously evaluate its diagnostic advantages through a controlled trial.

In this prospective study, 285 patients were finally analyzed. The per-patient diagnostic yields of GIM, GIN, and EGC were 36.6% and 23.8% in the ME-OE and WLE groups, respectively (P = .018). The per-lesion diagnostic yield of GIM, GIN, and EGC in the ME-OE group was higher than in the WLE group (66.7% vs 48.7%, P = .017). For GIM specifically, ME-OE showed better diagnostic efficacy in endoscopic-pathological correlation, particularly sensitivity (82.8% vs 54.3%, P = .003), positive predictive value (88.9% vs 70.4%, P = .038), and accuracy (83.3% vs 69.2%, P = .028).

Moreover, ME-OE could serve as a valuable tool to promote observer reliability of endoscopic diagnosis. These findings provide evidence for the diagnostic value of ME-OE in clinical practice for high-risk populations with gastric cancer. Future studies should explore its role across diverse populations and endoscopists, cost-effectiveness, and the impact of improved detection on long-term outcomes.

In conclusion, ME-OE showed better performance for detecting GIM than WLE in high-risk populations. ME-OE could be a promising tool to strengthen gastric cancer surveillance and prevention strategies.

Graphical abstract

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