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Although global age-standardised incidence of gastric cancer has declined, absolute case numbers continue to rise with population ageing and increasing early-onset disease. Early gastric cancer diagnosed at the mucosal stage offers excellent long-term survival and can often be treated endoscopically, making accurate detection critical. This review consolidates conventional endoscopic assessment, image-enhanced modalities, staging frameworks, and AI-assisted systems for diagnosing CAG, gastric intestinal metaplasia, and early neoplasia.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endoscopic-diagnosis-of-chronic-atrophic-gastritis-and-early-gastric-cancer-from-basics-to-advanced-imaging/363616/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endoscopic-diagnosis-of-chronic-atrophic-gastritis-and-early-gastric-cancer-from-basics-to-advanced-imaging/363616.png","ImageObject",300,407,{"name":92,"@type":93},"Franzy","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is accurate endoscopic diagnosis of CAG and early gastric cancer essential?","Question",{"text":113,"@type":114},"CAG is the principal precursor lesion for gastric adenocarcinoma and a target for surveillance, while early gastric cancer detected at the mucosal stage has an excellent prognosis and may be curable endoscopically. Accurate detection helps reduce gastric cancer mortality by identifying premalignant and early lesions.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What principles define high-quality oesophagogastroduodenoscopy for detection?",{"text":118,"@type":114},"High-quality examination emphasises careful mucosal inspection, adequate examination time, mucosal cleansing, and standardised photo-documentation. These practices support consistent and reliable assessment of mucosal abnormalities.",{"name":120,"@type":111,"acceptedAnswer":121},"Which advanced imaging and AI approaches are discussed, and what limitations remain?",{"text":122,"@type":114},"The review highlights image-enhanced modalities such as narrow-band imaging, linked colour imaging, and magnification-based optical enhancement, which improve visualisation of mucosal and vascular patterns. AI-assisted endoscopy shows promising diagnostic accuracy, but external validation, generalisability, and integration into routine practice still require further evidence.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},363616,1790197548,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146},2336478945519,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Review  \nEndoscopic Diagnosis of Chronic Atrophic Gastritis and Early Gastric Cancer: From Basics to Advanced Imaging  \nMatthew Banks * and David Graham  \nAcademic Editor: Hidekazu Suzuki  \nReceived: 12 May 2026  \nRevised: 28 May 2026  \nAccepted: 1 June 2026  \nPublished: 4 June 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of Gastroenterology, University College Hospital, London NW1 2PG, UK; [david.graham14@nhs.net](david.graham14@nhs.net)  \n* [Correspondence: matthew.banks2@nhs.net](Correspondence: matthew.banks2@nhs.net)  \nSimple Summary  \nChronic atrophic gastritis (CAG) is the main precursor lesion for gastric adenocarcinoma and an important target for endoscopic surveillance and early intervention. Although age-standardised gastric cancer rates have declined globally, total case numbers continue to rise due to ageing populations and an increasing incidence in younger individuals. Early gastric cancer detected at a mucosal stage carries an excellent prognosis and may be curable endoscopically, emphasising the importance of accurate endoscopic diagnosis. This review outlines current approaches to detecting CAG, gastric intestinal metaplasia (GIM), and early gastric cancer using both conventional and advanced endoscopic techniques. Key principles of high-quality oesophagogastroduodenoscopy include careful mucosal inspection, adequate examination time, mucosal cleansing, and standardised documentation. Advanced imaging modalities such as narrow-band imaging and linked colour imaging improve visualisation of mucosal and vascular patterns, thereby increasing diagnostic accuracy. Artificial intelligence-assisted endoscopy also shows promise in improving lesion detection and reducing miss rates, although further validation is required before widespread routine implementation.  \nAbstract  \nChronic atrophic gastritis (CAG) is the principal precursor lesion for gastric adenocarcinoma and represents a key target for endoscopic surveillance and early intervention. Although the global age-standardised incidence of gastric cancer has declined over recent decades, the absolute number of cases continues to rise because of population ageing and increasing incidence in younger individuals. The prognosis remains poor in advanced disease, whereas early gastric cancer (EGC) detected at a mucosal stage is associated with excellent long-term survival and may be curable with endoscopic resection. Consequently, high-quality endoscopic detection of premalignant gastric lesions is essential to reduce gastric cancer mortality. This review summarises current concepts in the endoscopic diagnosis of CAG, gastric intestinal metaplasia (GIM), and EGC, from conventional white-light endoscopy through to advanced imaging and artificial intelligence (AI)-assisted systems. Fundamental principles of high-quality oesophagogastroduodenoscopy are discussed, including adequate inspection time, systematic mucosal assessment, mucosal cleansing, and standardised photo-documentation. Characteristic endoscopic appearances of normal gastric mucosa, atrophy, and intestinal metaplasia are reviewed, alongside established staging systems including the Kimura–Takemoto and EGGIM classifications. The role of imageenhanced endoscopy is examined in detail, including narrow-band imaging, linked colour imaging, texture and colour enhancement imaging, and magnification optical enhancement. These modalities improve visualisation of pit patterns, microvascular architecture, and hallmark features of intestinal metaplasia such as the light blue crest sign, substantially  \nincreasing diagnostic sensitivity and specificity compared with conventional white light imaging alone. Advanced imaging combined with magnification also enhances the detection and characterisation of EGC. Emerging evidence regarding AI-assiste","cbCaignscLMcLnTZ","https://ap.wps.com/l/cbCaignscLMcLnTZ","pdf",1499009,18,"English","# Introduction\n## Chronic atrophic gastritis as a precursor\n## Global trends in gastric cancer incidence and mortality\n# Summary of key diagnostic principles and rationale\n## High-quality oesophagogastroduodenoscopy and standardised documentation\n# Conventional and advanced endoscopic approaches\n## White-light endoscopy and characteristic appearances\n## Image-enhanced endoscopy and magnification\n# Staging systems and classification of disease\n## Kimura–Takemoto and EGGIM classifications\n# Artificial intelligence-assisted endoscopy\n## Diagnostic accuracy and limitations","[{\"question\":\"Why is accurate endoscopic diagnosis of CAG and early gastric cancer essential?\",\"answer\":\"CAG is the principal precursor lesion for gastric adenocarcinoma and a target for surveillance, while early gastric cancer detected at the mucosal stage has an excellent prognosis and may be curable endoscopically. Accurate detection helps reduce gastric cancer mortality by identifying premalignant and early lesions.\"},{\"question\":\"What principles define high-quality oesophagogastroduodenoscopy for detection?\",\"answer\":\"High-quality examination emphasises careful mucosal inspection, adequate examination time, mucosal cleansing, and standardised photo-documentation. These practices support consistent and reliable assessment of mucosal abnormalities.\"},{\"question\":\"Which advanced imaging and AI approaches are discussed, and what limitations remain?\",\"answer\":\"The review highlights image-enhanced modalities such as narrow-band imaging, linked colour imaging, and magnification-based optical enhancement, which improve visualisation of mucosal and vascular patterns. AI-assisted endoscopy shows promising diagnostic accuracy, but external validation, generalisability, and integration into routine practice still require further evidence.\"}]","Endoscopic Diagnosis of Chronic Atrophic Gastritis and Early Gastric Cancer: From Basics to Advanced Imaging | PDF",1790152160,45]