Endomicroscopy of Gastritis and Gastric Cancer

Abstract

Endoscopy and histopathology are approaching each other more and more. Sophisticated techniques such as chromoendoscopy and enhanced magnification give detailed information about the gastrointestinal surface structure. Several studies have demonstrated the value of these techniques, with regard to the stomach, particularly for differentiation between neoplastic and non-neoplastic changes. Chromoendoscopy is used to highlight the pit pattern structure of the mucosal surface, allowing the endoscopist to determine the nature of gastric lesions from indirect criteria. Magnification endoscopy is able to visualise surface structures with increased detail due to magnification factors of 80–150. However, neither of these techniques is able to look below the mucosal surface. Confocal laser endomicroscopy (CLE) enables a microscopic tissue analysis in vivo during ongoing endoscopy. The magnification factor in endomicroscopy is about 1000 × and permits the analysis of tissue pattern and microvascular architecture. For an adequate interpretation of the confocal images a knowledge of histopathology and of the endomicroscopic appearance of normal tissue is essential, especially where non-neoplastic versus neoplastic changes are concerned.