• Diagnosis
• Endoscopy
• Neoplasm
• Stomach

• Endocytoscopy (EC)
• diagnosis
• endoscopy
• ultra-high magnification endoscopy

Among the methods developed to detect H. pylori infection, determining the gold standard remains debatable, especially for epidemiological studies. Due to the decreasing sensitivity of direct diagnostic tests (histopathology and/or immunohistochemistry [IHC], rapid urease test [RUT], and culture), several indirect tests, including antibody-based tests (serology and urine test), urea breath test (UBT), and stool antigen test (SAT) have been developed to diagnose H. pylori infection. Among the indirect tests, UBT and SAT became the best methods to determine active infection. While antibody-based tests, especially serology, are widely available and relatively sensitive, their specificity is low. Guidelines indicated that no single test can be considered as the gold standard for the diagnosis of H. pylori infection and that one should consider the method's advantages and disadvantages. Based on four epidemiological studies, culture and RUT present a sensitivity of 74.2–90.8% and 83.3–86.9% and a specificity of 97.7–98.8% and 95.1–97.2%, respectively, when using IHC as a gold standard. The sensitivity of serology is quite high, but that of the urine test was lower compared with that of the other methods. Thus, indirect test validation is important although some commercial kits propose universal cut-off values.

• advanced endoscopic imaging
• endocytoscopy
• endomicroscopy
• endoscopy
• ulcerative colitis

Infection with Helicobacter pylori (H. pylori) is a worldwide problem. Endoscopic observation of H. pylori infection in vivo would be helpful to obtain an immediate diagnosis. The aim of this review is to describe recent advances in endoscopic technology and to review the available literature pertaining to its clinical application in H. pylori infection. Endoscopic visualization of H. pylori infection is not always feasible using conventional endoscopy. Thus, advanced endoscopic techniques have been developed with the aim of providing a precise and ‘‘real-time’’ endoscopic diagnosis. Recently, new endoscopic techniques such as magnifying endoscopy, narrow band imaging, I-Scan, endocytoscopy and endomicroscopy help focus examination of the stomach to diagnose disease in a time-efficient manner, and the analysis of mucosal surface details is beginning to resemble histologic examination. The new detailed images have enabled endoscopists to observe microscopic structures, such as gastric pit patterns, microvessels and cell morphology. Accordingly, endoscopic prediction of H. pylori infection is possible by analysis of surface architecture of the mucosa, which influences the clinical management. These endoscopic techniques might lead us to easier diagnosis and treatment of H. pylori-related diseases.

• Helicobacter pylori
• Diagnosis
• Gastrointestinal endoscopy

• Biopsy
• Gastric Mucosa/microbiology
• Gastric Mucosa/pathology
• Gastroscopy/methods
• Helicobacter Infections/diagnosis
• Helicobacter Infections/microbiology
• Helicobacter Infections/pathology
• Helicobacter pylori/isolation & purification
• Humans
• Image Interpretation, Computer-Assisted
• Microscopy, Confocal
• Predictive Value of Tests
• Prognosis
• Spectrum Analysis, Raman
• Stomach/microbiology
• Stomach/pathology

Endoscopy is an indispensible diagnostic and therapeutic instrument for gastrointestinal diseases. Endocytoscopy and confocal endomicroscopy are two types of ultra high magnification endoscopy techniques. Standard endoscopy allows for 50 × magnification, whereas endocytoscopy can magnify up to 1400 × and confocal endomicroscopy can magnify up to 1000 ×. These methods open the realm of real time microscopic evaluation of the GI tract, including cellular and subcellular structures. Confocal endomicroscopy has the additional advantage of being able to visualize subsurface structures. The use of high magnification endoscopy in conjunction with standard endoscopy allows for a real-time microscopic assessment of areas with macroscopic abnormalities, providing “virtual biopsies” with valuable information about cellular and subcellular changes. This can minimize the number of biopsies taken at the time of endoscopy. The use of this technology may assist in detecting pre-malignant or malignant changes at an earlier state, allowing for earlier intervention and treatment. High magnification endoscopy has shown promising results in clinical trials for Barrett’s esophagus, esophageal adenocarcinoma, esophageal squamous cell cancer, gastric cancer, celiac disease, colorectal cancer, and inflammatory bowel disease. As the use of high magnification endoscopy techniques increases, the clinical applications will increase as well. Of the two systems, only confocal endomicroscopy is currently commercially available. Like all new technologies there will be an initial learning curve before operators become proficient in obtaining high quality images and discerning abnormal from normal pathology. Validated criteria for the diagnosis of the various gastrointestinal diseases will need to be developed for each method. In this review, the basic principles of both modalities are discussed, along with their clinical applicability and limitations.

• Endocytoscopy
• Confocal endomicroscopy
• Confocal laser endomicroscopy
• High magnification endoscopy

• endocytoscopy
• advanced endoscopy imaging
• magnification endoscopy
• real-time histology

• Computer Systems/trends
• Endoscopy, Gastrointestinal/instrumentation
• Endoscopy, Gastrointestinal/methods
• Endoscopy, Gastrointestinal/trends
• Gastrointestinal Tract/pathology
• Histological Techniques
• Histology/instrumentation
• Histology/trends
• Humans
• Mucous Membrane/pathology

• Adult
• Antibodies, Bacterial/blood
• Antigens, Bacterial/analysis
• Breath Tests
• Child
• Child, Preschool
• Drug Resistance, Bacterial/genetics
• Endoscopy
• Feces/microbiology
• Helicobacter Infections/diagnosis
• Helicobacter Infections/microbiology
• Helicobacter pylori/classification
• Helicobacter pylori/genetics
• Helicobacter pylori/immunology
• Helicobacter pylori/isolation & purification
• Humans
• Polymerase Chain Reaction
• Reagent Kits, Diagnostic