Gastric Intestinal Metaplasia

A patient with H. pylori-associated chronic atrophic gastritis received gastroscopic examination. The antral mucosa looked having a mosaic of red and white colors (Fig. a). Texture and color enhancement imaging (TXI) mode enhanced the difference in colors (Fig. b). Narrowband imaging (NBI) revealed multiple whitish patches (Fig. c, yellow arrows), indicating the presence of gastric intestinal metaplasia (GIM). Magnifying NBI image distinguished an area with the GIM, in which the light blue crest (LBC) is seen (yellow box in Fig. d), from an area of the non-metaplastic mucosa (white box in Fig. d). Ultra-magnifying NBI image of the non-metaplastic mucosa showed homogeneous cellular structure in the marginal crypt epithelium with smooth margin (Fig. e). Ultra-magnifying NBI image of the GIM showed the marginal crypt epithelium with rough margin and the LBC (Fig. f); heterogeneous cellular structure in the marginal crypt epithelium including sporadic large cells, which is speculated as goblet cells (Fig. g, white arrows); and white opaque substance (WOS) in the marginal crypt epithelium (Fig. h).