Masterclass: Advanced GI Endoscopic Imaging (Live/Virtual) | December 2025-Bechara - Optimizing Detection of Gastric Neoplasia

Bechara - Optimizing Detection of Gastric Neoplasia

Pdf Summary

This presentation by Dr. Robert Bechara focuses on optimizing the detection of gastric neoplasia through advanced endoscopic imaging techniques. Gastric cancer is frequently missed during routine esophagogastroduodenoscopy (EGD), with a pooled miss rate of approximately 9.4% and even higher rates for synchronous lesions. Missed cancers are more common in younger patients, females, and those with gastric atrophy, ulcers, or adenomas.<br /><br />Improving detection relies heavily on awareness and training since early neoplastic changes can be subtle and easily overlooked. The presentation emphasizes understanding normal gastric mucosa microstructure and employing a structured, systematic approach to gastric examination. This includes a systematic screening protocol (SSP), which observational studies suggest increases detection of clinically significant lesions, though randomized controlled trials have not yet confirmed this definitively. Guidelines endorse systematic, photo-documented exams to enhance quality and early neoplasia identification.<br /><br />Key endoscopic features for early gastric cancer diagnosis include recognizing irregular microvascular and microsurface patterns and demarcation lines using high-resolution and magnifying endoscopy techniques such as Narrow Band Imaging (NBI), Blue Laser Imaging (BLI), and Linked Color Imaging (LCI). These image-enhancement technologies have demonstrated improved detection rates in trials compared to conventional white light imaging.<br /><br />Optimization strategies also include adequate procedure time (at least 7 minutes), premedication with simethicone-mucolytics to improve mucosal visualization, and training to increase diagnostic accuracy. Case studies illustrate how systematic examination and image-enhancement techniques enable early identification and successful management of gastric neoplasia.<br /><br />In conclusion, thorough cleaning, careful macroscopic and microscopic mucosal examination using white light and image-enhanced endoscopy, combined with a systematic approach, can significantly improve early gastric cancer detection, ultimately improving patient outcomes and survival.

Keywords

gastric neoplasia

gastric cancer detection

endoscopic imaging

esophagogastroduodenoscopy (EGD)

systematic screening protocol (SSP)

high-resolution endoscopy

Narrow Band Imaging (NBI)

Blue Laser Imaging (BLI)

Linked Color Imaging (LCI)

image-enhanced endoscopy