Atrophic Gastritis, Intestinal Metaplasia Diagnostic Yield Similar With i-Scan, HD-WLE

Intestinal metaplasia of stomach, light micrograph, photo under microscope
Fewer biopsies were needed to confirm gastric precancerous lesions using the i-scan technology than with high-definition white-light endoscopy.

Targeted biopsies with i-scan were not significantly superior to targeted or random biopsies with high-definition white-light endoscopy (HD-WLE), although the number of biopsies required to confirm gastric precancerous lesions was much lower, according to a study in the Arab Journal of Gastroenterology.

Researchers aimed to determine whether i-scan provides additional benefits to conventional endoscopy in the diagnosis of atrophic gastritis (AG) and intestinal metaplasia (IM).

The trial included patients who were undergoing screening or surveillance for IM or AG at a center in Istanbul, Turkey, between January 2016 and December 2017. Eligible participants were all older than18 years of age and were diagnosed with Helicobacter pylori (HP) infection within the last year or had histologically verified AG or IM.

The procedures were performed with use of an i-scan video gastroscope. During HD-WLE, no enhancement features were used. The biopsy samples were assessed for gastritis, HP infection, AG, and IM by 2 experienced gastrointestinal pathologists who were blinded to the endoscopic diagnosis and previous histologic findings.

A total of 120 patients (HP, n=35; AG, n=42; IM, n=43) were included (mean age, 54.4±9.8 years [range, 28-75 years]; 55.8% women). Among the cohort, 318 suspicious lesions were detected in 81 patients with HD-WLE (132 lesions) and 108 patients with i-scan (186 lesions).

No significant difference was found in the number of lesions detected by the 2 methods (P >.05). In the per patient assessment, the diagnostic yields for IM/AG/malignancy were 77.5% (93/120) with HD-WLE and 81.6% (98/120) with i-scan (P =.63).

After the investigators omitted the number of biopsies performed according to the Sydney protocol and focused solely on the targeted biopsies for suspicious lesions with both endoscopic techniques, the diagnostic yields per patient assessment for IM/AG/malignancy were 65.4% (53/81) with HD-WLE and 89.8% (97/198) with i-scan (P <.05).

The mean number of biopsies per patient on HD-WLE and i-scan were 7.3 (882/120; range, 5-13) and 3.27 (393/120; range, 0-7), respectively. Based on the analyses per biopsy, the use of i-scan resulted in a significant 55.2% decrease in the number of biopsies obtained per patient (P <.05). The mean endoscopic procedure time was 17 minutes (range, 10-29) with HD-WLE and 16 minutes (range, 11-31) with i-scan. I-scan imaging did not extend processing time (P >.05).

Study limitations include the inability to evaluate the pathologic subtypes of IM, the limited number of patients, the single-center design, and the use of both endoscopy techniques during the same session.

The “i-scan endoscopy is cheaper, more accessible, and easier to use than other recently developed endoscopic methods,” stated the study authors. “It is a simple and accurate means of diagnosis and follow-up of gastric precancerous lesions. Nevertheless, multicenter studies with larger patient samples are needed to confirm our results.”


Tosun Y, Velidedeoğlu M, Akıncı O, Ferahman S, Kepil N, Tortum OB. Comparison of the effectiveness of i-scan and conventional endoscopy in the detection of the endoscopic signs of atrophic gastritis: a clinical trial. Arab J Gastroenterol. Published online April 23, 2022. doi:10.1016/j.ajg.2021.12.001