Dual-focus narrow band imaging for the detection of intestinal metaplasia and atrophic gastritis

Gastric cancer is one of the most common neoplastic diseases in developed Western countries, and is characterized by a poor prognosis when diagnosed at a late stage [1]. Atrophic gastritis and gastric intestinal metaplasia (GIM) are well-known risk factors for the development of gastric cancer. For this reason, endoscopy with multiple biopsies is recommended in patients with atrophic gastritis or GIM, to exclude preneoplastic or neoplastic tissue [1]. Magnifying endoscopy with narrow band imaging (NBI) has been shown to be reliable for in vivo diagnosis of atrophic gastritis and GIM [1] [2] [3] [4]. However, while magnifying endoscopy is routinely used by Asian endoscopists, it is not established in most European and Northern American endoscopy centers. Recently, a novel endoscope with NBI and dual-focus capability has been introduced to improve the quality of endoscopic imaging [5]. Dual focus allows the user to select between two focus settings by pushing a button on the scope. This results in an optimized close view of the tissue up to an 80-fold optical magnification. To the best of our knowledge, no reports exist so far on the use of this new technique for the detection and characterization of gastric lesions. We report a case in which dual-focus narrow band imaging was used to diagnose atrophic gastritis with intestinal metaplasia and obtain targeted biopsies in the same session.