Confocal Laser Endomicroscopy for the Diagnosis of Gastric Intestinal Metaplasia, Intraepithelial Neoplasia, and Carcinoma
Confocal Laser Endomicroscopy for the Diagnosis of Gastric Intestinal Metaplasia, Intraepithelial Neoplasia, and Carcinoma
i. To determine whether Confocal Laser Endomicroscopy (CLE) with optical biopsy and targeted
 mucosal biopsy improves the diagnostic yield of gastric IM/IN/CA in high risk populations
 compared to WLE with standard biopsy protocol.

 ii. To determine whether CLE with optical biopsy and targeted biopsy, as compared to WLE with
 standard biopsy, can reduce the number of biopsies needed per patient for detection of
 gastric IM/IN/carcinoma without the loss of corresponding diagnostic yield.

 iii. To compare the sensitivity and specificity of CLE with WLE for the detection of gastric
 IM/IN/CA.
Gastric cancer remains the world's second leading cause of cancer-related deaths. The
 prognosis for patients with this cancer clearly depends on stage at diagnosis. At least for
 the intestinal subtype of gastric adenocarcinoma, a cascade of histopathologic lesions has
 been defined: chronic gastritis, atrophic chronic gastritis, intestinal metaplasia (IM), and
 intraepithelial neoplasia (IN). The identification of these lesions and follow-up of patients
 in whom they are found could lead to diagnosis of gastric cancer at an early stage, thus
 improving patients' survival. The diagnosis of these lesions, which often appear in flat
 mucosa, is currently based on histopathologic examination of endoscopic biopsy specimens.
 However, conventional white-light endoscopy (WLE) for this purpose has high interobserver
 variability and a poor correlation with histopathologic finding.

 Confocal laser endomicroscopy (CLE), producing both conventional WLE and confocal microscopic
 images, can provide a direct histological observation of the in vivo tissue without the need
 for biopsy. Recently, CLE has shown its value for diagnosing gastric IM, intraepithelial
 neoplasia and carcinoma. However, none of those CLE criteria for gastric IM, IN or carcinoma
 (CA) has been validated in various endoscopic centers, hence reducing the reliability and
 clinical application of them.
Inclusion Criteria:

 -  Male or Female aged 18-80

 -  Patients with H. pylori infection, or histologically verified gastric intestinal
 metaplasia, low-grade intraepithelial neoplasia, and atrophic gastritis

 Exclusion Criteria:

 -  Patients with gastrectomy, acute GI bleeding, and advanced gastric cancer

 -  Patients under conditions unsuitable for performing CLE including coagulopathy,
 impaired renal function, pregnancy or breastfeeding, and known allergy to fluorescein
 sodium

 -  Inability to provide informed consent and other situations that could interfere with
 the examination protocol